"Procedure"|"Code Type"|"Revenue Code"|"Procedure Description"|"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"
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|15.13||||15.13|11.95|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.13||||15.13|4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|15.13||||15.13|11.95|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|TRUSTMARK [2030]|STARMARK [203000]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|15.13||||15.13|4.28|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|15.13||||15.13|12.86|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|15.13||||15.13|6.81|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|15.13||||15.13|11.95|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|15.13||||15.13|8.32|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|15.13||||15.13|6.81|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|15.13||||15.13|11.95|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|15.13||||15.13|7.26|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|15.13||||15.13|8.32|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|15.13||||15.13|8.05|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|WEB TPA [2115]|WEB TPA [211500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|GILSBAR [1425]|GILSBAR [142500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|15.13||||15.13|8.05|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MEDICA [2910]|MEDICA QUEST [291001]|15.13||||15.13|8.05|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHNET [1495]|HEALTHNET [149500]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|<Self-pay>|<Self-pay>|15.13||||15.13|4.54|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|15.13||||15.13|11.95|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MULTIPLAN [1680]|IHC HS [168011]|15.13||||15.13|12.4|12.86|4
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|CIGNA [1260]|CIGNA [126008]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|UMR [2035]|UMR CORE [203505]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|15.13||||15.13|||
100012|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WIRE FIXATION KIRSCHNER STAINLESS STEEL L6 IN OD.062 IN 1 END TROCAR POINT SMOOTH PLAIN NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|15.13||||15.13|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|604.03||||604.03|159.89|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|604.03||||604.03|181.21|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|BENVEO/UCS [137512]|604.03||||604.03|321.35|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|604.03||||604.03|477.19|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|604.03||||604.03|271.81|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|604.03||||604.03|477.19|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|604.03||||604.03|321.35|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|604.03||||604.03|271.81|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|604.03||||604.03|332.22|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|604.03||||604.03|289.94|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|604.03||||604.03|332.22|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|604.03||||604.03|477.19|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|604.03||||604.03|513.43|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|604.03||||604.03|170.94|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|604.03||||604.03|477.19|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|604.03||||604.03|477.19|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDICA [2910]|MEDICA QUEST [291001]|604.03||||604.03|321.35|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|604.03||||604.03|495.31|513.43|159.89
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA ACO WILCO [101532]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR CORE [203505]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131501]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA [126008]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|TULSA BLUE [115531]|604.03||||604.03|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|604.03||||604.03|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|3320.00||||3320.00|2622.8|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3320.00||||3320.00|1272.56|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|3320.00||||3320.00|2622.8|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3320.00||||3320.00|1766.24|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3320.00||||3320.00|1394.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHNET [1495]|HEALTHNET [149500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3320.00||||3320.00|1826|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3320.00||||3320.00|939.56|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MULTIPLAN [1680]|IHC HS [168011]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3320.00||||3320.00|1494|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|WEB TPA [2115]|WEB TPA [211500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|GILSBAR [1425]|GILSBAR [142500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3320.00||||3320.00|1593.6|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3320.00||||3320.00|1826|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3320.00||||3320.00|878.8|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|3320.00||||3320.00|2822|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MEDICA [2910]|MEDICA QUEST [291001]|3320.00||||3320.00|1766.24|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|CIGNA [1260]|CIGNA [126008]|3320.00||||3320.00|1394.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3320.00||||3320.00|1272.56|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|3320.00||||3320.00|2622.8|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|3320.00||||3320.00|1766.24|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|TRUSTMARK [2030]|STARMARK [203000]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3320.00||||3320.00|2622.8|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|3320.00||||3320.00|1272.56|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3320.00||||3320.00|2622.8|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|<Self-pay>|<Self-pay>|3320.00||||3320.00|996|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3320.00||||3320.00|1494|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|CORESOURCE [1315]|CORESOURCE [131501]|3320.00||||3320.00|1272.56|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3320.00||||3320.00|2722.4|2822|878.8
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|GEHA [1415]|GEHA - ASA [141503]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|CHAMPVA [1240]|CHAMP VA [124000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BCBS [1155]|TULSA BLUE [115531]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|UMR [2035]|UMR CORE [203505]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3320.00||||3320.00|||
100048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL 12MM PRESS FIT ECHO PF TITANIUM STANDARD OFFSET HIP STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3320.00||||3320.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|64.74||||64.74|34.18|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|64.74||||64.74|51.14|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHFIRST [2395]|HEALTHFIRST [239500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA [126008]|64.74||||64.74|34.18|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GILSBAR [1425]|GILSBAR [142500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|64.74||||64.74|51.14|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|64.74||||64.74|22.46|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|64.74||||64.74|51.14|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|64.74||||64.74|22.46|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FMH BENEFIT SERVICES [1390]|FMH [139000]|64.74||||64.74|51.14|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|64.74||||64.74|31.08|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|64.74||||64.74|34.44|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDICA [2910]|MEDICA QUEST [291001]|64.74||||64.74|34.44|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|IHC HS [168011]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|64.74||||64.74|19.42|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|64.74||||64.74|17.14|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|64.74||||64.74|22.46|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|64.74||||64.74|22.46|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|64.74||||64.74|55.03|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|64.74||||64.74|36.9|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|64.74||||64.74|35.61|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|64.74||||64.74|51.14|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|64.74||||64.74|18.32|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|64.74||||64.74|29.13|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|64.74||||64.74|53.09|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|64.74||||64.74|34.44|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|64.74||||64.74|29.13|55.03|17.14
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|TULSA BLUE [115531]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR CORE [203505]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|64.74||||64.74|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|64.74||||64.74|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|TRUSTMARK [2030]|STARMARK [203000]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|24.63||||24.63|19.45|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|FIRST HEALTH [1375]|BENVEO/UCS [137512]|24.63||||24.63|13.1|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CORESOURCE [1315]|CORESOURCE [131501]|24.63||||24.63|8.54|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHFIRST [2395]|HEALTHFIRST [239500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CIGNA [1260]|CIGNA [126008]|24.63||||24.63|13|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|24.63||||24.63|19.45|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MEDICA [2910]|MEDICA QUEST [291001]|24.63||||24.63|13.1|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.63||||24.63|6.52|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|24.63||||24.63|8.54|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.63||||24.63|19.45|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA [1015]|AETNA ACO WILCO [101532]|24.63||||24.63|8.54|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MULTIPLAN [1680]|IHC HS [168011]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|<Self-pay>|<Self-pay>|24.63||||24.63|7.39|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|24.63||||24.63|11.08|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|24.63||||24.63|13.1|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.63||||24.63|19.45|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GILSBAR [1425]|GILSBAR [142500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|24.63||||24.63|20.93|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|24.63||||24.63|11.82|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|24.63||||24.63|11.08|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|24.63||||24.63|6.97|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHNET [1495]|HEALTHNET [149500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|24.63||||24.63|19.45|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|WEB TPA [2115]|WEB TPA [211500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|24.63||||24.63|13.54|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|24.63||||24.63|14.04|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|24.63||||24.63|20.19|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|24.63||||24.63|8.54|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|24.63||||24.63|13|20.93|6.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR [2035]|UMR CORE [203505]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CHAMPVA [1240]|CHAMP VA [124000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GEHA [1415]|GEHA - ASA [141503]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|TULSA BLUE [115531]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.63||||24.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|24.63||||24.63|8.54|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|WEB TPA [2115]|WEB TPA [211500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHNET [1495]|HEALTHNET [149500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|24.63||||24.63|13.54|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|24.63||||24.63|6.97|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|24.63||||24.63|13|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|24.63||||24.63|11.08|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|24.63||||24.63|13.1|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|IHC HS [168011]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|24.63||||24.63|8.54|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24.63||||24.63|19.45|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|24.63||||24.63|19.45|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|24.63||||24.63|14.04|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|TRUSTMARK [2030]|STARMARK [203000]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MEDICA [2910]|MEDICA QUEST [291001]|24.63||||24.63|13.1|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|24.63||||24.63|8.54|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|24.63||||24.63|19.45|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|24.63||||24.63|19.45|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|24.63||||24.63|13|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GILSBAR [1425]|GILSBAR [142500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|24.63||||24.63|20.93|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|24.63||||24.63|11.82|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24.63||||24.63|20.19|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|24.63||||24.63|11.08|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24.63||||24.63|19.45|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24.63||||24.63|6.52|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|<Self-pay>|<Self-pay>|24.63||||24.63|7.39|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|24.63||||24.63|13.1|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|24.63||||24.63|8.54|20.93|6.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24.63||||24.63|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24.63||||24.63|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|301.18||||301.18|165.65|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|301.18||||301.18|237.93|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|301.18||||301.18|104.51|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WEB TPA [2115]|WEB TPA [211500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|301.18||||301.18|171.67|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|301.18||||301.18|237.93|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|301.18||||301.18|159.02|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|301.18||||301.18|85.23|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|301.18||||301.18|135.53|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|301.18||||301.18|160.23|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDICA [2910]|MEDICA QUEST [291001]|301.18||||301.18|160.23|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHFIRST [2395]|HEALTHFIRST [239500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|301.18||||301.18|237.93|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|301.18||||301.18|256|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|301.18||||301.18|144.57|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131501]|301.18||||301.18|104.51|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GILSBAR [1425]|GILSBAR [142500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|301.18||||301.18|246.97|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|301.18||||301.18|104.51|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|301.18||||301.18|237.93|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA [126008]|301.18||||301.18|159.02|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FMH BENEFIT SERVICES [1390]|FMH [139000]|301.18||||301.18|237.93|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|301.18||||301.18|104.51|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|301.18||||301.18|79.72|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|301.18||||301.18|90.35|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|301.18||||301.18|135.53|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|BENVEO/UCS [137512]|301.18||||301.18|160.23|256|79.72
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|TULSA BLUE [115531]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR CORE [203505]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|301.18||||301.18|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|301.18||||301.18|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1612.00||||1612.00|677.04|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1612.00||||1612.00|886.6|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1612.00||||1612.00|617.88|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1612.00||||1612.00|1273.48|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1612.00||||1612.00|857.58|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1612.00||||1612.00|725.4|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1612.00||||1612.00|1273.48|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1612.00||||1612.00|617.88|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1612.00||||1612.00|725.4|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1612.00||||1612.00|456.2|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131501]|1612.00||||1612.00|617.88|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1612.00||||1612.00|773.76|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1612.00||||1612.00|1370.2|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1612.00||||1612.00|1273.48|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1612.00||||1612.00|1273.48|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA [126008]|1612.00||||1612.00|677.04|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MEDICA [2910]|MEDICA QUEST [291001]|1612.00||||1612.00|857.58|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1612.00||||1612.00|857.58|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1612.00||||1612.00|1321.84|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1612.00||||1612.00|1273.48|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1612.00||||1612.00|426.7|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1612.00||||1612.00|617.88|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1612.00||||1612.00|886.6|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1612.00||||1612.00|483.6|1370.2|426.7
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|TULSA BLUE [115531]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR CORE [203505]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1612.00||||1612.00|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1612.00||||1612.00|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1612.00||||1612.00|1273.48|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1612.00||||1612.00|773.76|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|GILSBAR [1425]|GILSBAR [142500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MEDICA [2910]|MEDICA QUEST [291001]|1612.00||||1612.00|857.58|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1612.00||||1612.00|857.58|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1612.00||||1612.00|617.88|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1612.00||||1612.00|1273.48|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|CORESOURCE [1315]|CORESOURCE [131501]|1612.00||||1612.00|617.88|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1612.00||||1612.00|1273.48|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1612.00||||1612.00|426.7|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|1612.00||||1612.00|617.88|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|<Self-pay>|<Self-pay>|1612.00||||1612.00|483.6|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1612.00||||1612.00|725.4|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1612.00||||1612.00|1273.48|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|CIGNA [1260]|CIGNA [126008]|1612.00||||1612.00|677.04|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1612.00||||1612.00|1370.2|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1612.00||||1612.00|886.6|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1612.00||||1612.00|677.04|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1612.00||||1612.00|1273.48|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1612.00||||1612.00|456.2|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1612.00||||1612.00|886.6|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1612.00||||1612.00|857.58|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1612.00||||1612.00|617.88|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1612.00||||1612.00|1321.84|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1612.00||||1612.00|725.4|1370.2|426.7
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UMR [2035]|UMR CORE [203505]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|TULSA BLUE [115531]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1612.00||||1612.00|1273.48|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1612.00||||1612.00|677.04|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1612.00||||1612.00|886.6|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1612.00||||1612.00|456.2|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1612.00||||1612.00|886.6|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1612.00||||1612.00|725.4|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1612.00||||1612.00|1273.48|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1612.00||||1612.00|725.4|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|1612.00||||1612.00|617.88|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1612.00||||1612.00|1273.48|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1612.00||||1612.00|617.88|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1612.00||||1612.00|617.88|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1612.00||||1612.00|1273.48|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1612.00||||1612.00|857.58|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|GILSBAR [1425]|GILSBAR [142500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MEDICA [2910]|MEDICA QUEST [291001]|1612.00||||1612.00|857.58|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|CORESOURCE [1315]|CORESOURCE [131501]|1612.00||||1612.00|617.88|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1612.00||||1612.00|857.58|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1612.00||||1612.00|426.7|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1612.00||||1612.00|773.76|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1612.00||||1612.00|1370.2|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|CIGNA [1260]|CIGNA [126008]|1612.00||||1612.00|677.04|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|<Self-pay>|<Self-pay>|1612.00||||1612.00|483.6|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1612.00||||1612.00|1273.48|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1612.00||||1612.00|1321.84|1370.2|426.7
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UMR [2035]|UMR CORE [203505]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|TULSA BLUE [115531]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1612.00||||1612.00|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1612.00||||1612.00|1273.48|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1612.00||||1612.00|773.76|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MEDICA [2910]|MEDICA QUEST [291001]|1612.00||||1612.00|857.58|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1612.00||||1612.00|617.88|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CORESOURCE [1315]|CORESOURCE [131501]|1612.00||||1612.00|617.88|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1612.00||||1612.00|1273.48|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1612.00||||1612.00|426.7|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA [126008]|1612.00||||1612.00|677.04|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1612.00||||1612.00|617.88|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1612.00||||1612.00|483.6|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1612.00||||1612.00|725.4|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1612.00||||1612.00|1273.48|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1612.00||||1612.00|886.6|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1612.00||||1612.00|886.6|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1612.00||||1612.00|1273.48|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1612.00||||1612.00|857.58|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1612.00||||1612.00|677.04|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1612.00||||1612.00|1273.48|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1612.00||||1612.00|456.2|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1612.00||||1612.00|1370.2|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1612.00||||1612.00|857.58|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1612.00||||1612.00|725.4|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1612.00||||1612.00|617.88|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1612.00||||1612.00|1321.84|1370.2|426.7
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR CORE [203505]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|TULSA BLUE [115531]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1612.00||||1612.00|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|9.45||||9.45|5.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|9.45||||9.45|2.67|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|9.45||||9.45|2.67|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|9.45||||9.45|5.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|9.45||||9.45|5.2|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|9.45||||9.45|5.2|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|9.45||||9.45|5.39|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|9.45||||9.45|5.39|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|9.45||||9.45|4.25|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|9.45||||9.45|2.83|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|9.45||||9.45|2.83|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9.45||||9.45|2.5|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|9.45||||9.45|4.25|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|9.45||||9.45|5.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|9.45||||9.45|4.99|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|9.45||||9.45|4.99|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|9.45||||9.45|5.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9.45||||9.45|2.5|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|9.45||||9.45|4.25|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|9.45||||9.45|4.25|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|9.45||||9.45|5.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|9.45||||9.45|3.28|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|9.45||||9.45|5.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9.45||||9.45|4.54|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9.45||||9.45|4.54|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|9.45||||9.45|7.47|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|9.45||||9.45|8.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|9.45||||9.45|8.03|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|9.45||||9.45|4.99|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|9.45||||9.45|4.99|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9.45||||9.45|7.75|8.03|2.5
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|9.45||||9.45|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|9.45||||9.45|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|12.53||||12.53|10.65|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|12.53||||12.53|9.9|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|12.53||||12.53|6.67|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|12.53||||12.53|6.67|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.53||||12.53|4.35|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.53||||12.53|4.35|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.53||||12.53|9.9|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.53||||12.53|3.32|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.53||||12.53|6.62|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.53||||12.53|6.01|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|<Self-pay>|<Self-pay>|12.53||||12.53|3.76|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.53||||12.53|5.64|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.53||||12.53|4.35|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.53||||12.53|4.35|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.53||||12.53|9.9|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.53||||12.53|6.89|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.53||||12.53|6.62|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.53||||12.53|7.14|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|12.53||||12.53|9.9|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.53||||12.53|3.55|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|12.53||||12.53|9.9|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.53||||12.53|6.67|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|12.53||||12.53|10.27|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.53||||12.53|5.64|10.65|3.32
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR [2035]|UMR CORE [203505]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.53||||12.53|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.53||||12.53|5.64|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.53||||12.53|5.64|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.53||||12.53|3.55|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.53||||12.53|3.55|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.53||||12.53|5.64|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.53||||12.53|6.62|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.53||||12.53|6.89|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.53||||12.53|6.89|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.53||||12.53|7.14|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.53||||12.53|6.89|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.53||||12.53|7.14|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.53||||12.53|7.14|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.53||||12.53|6.62|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.53||||12.53|5.64|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.53||||12.53|5.64|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|<Self-pay>|<Self-pay>|12.53||||12.53|3.76|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.53||||12.53|3.32|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.53||||12.53|3.32|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.53||||12.53|3.32|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.53||||12.53|5.64|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.53||||12.53|6.62|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR CORE [203505]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR CORE [203505]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR CORE [203505]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|<Self-pay>|<Self-pay>|12.53||||12.53|3.76|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|<Self-pay>|<Self-pay>|12.53||||12.53|3.76|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.53||||12.53|3.55|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.53||||12.53|6.01|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.53||||12.53|6.01|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.53||||12.53|6.01|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|12.53||||12.53|9.9|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|12.53||||12.53|10.65|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|12.53||||12.53|10.65|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|12.53||||12.53|10.65|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.53||||12.53|4.35|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.53||||12.53|6.62|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.53||||12.53|6.62|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.53||||12.53|6.62|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|12.53||||12.53|10.27|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|12.53||||12.53|6.67|10.65|3.32
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.53||||12.53|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.53||||12.53|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|52.26||||52.26|18.37|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|52.26||||52.26|44.42|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|52.26||||52.26|41.29|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MEDICA [2910]|MEDICA QUEST [291001]|52.26||||52.26|27.8|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GILSBAR [1425]|GILSBAR [142500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|52.26||||52.26|18.13|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131501]|52.26||||52.26|18.13|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.26||||52.26|41.29|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.26||||52.26|13.83|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|52.26||||52.26|25.08|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|52.26||||52.26|15.68|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|52.26||||52.26|23.52|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|52.26||||52.26|18.13|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|WEB TPA [2115]|WEB TPA [211500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|52.26||||52.26|18.13|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.26||||52.26|41.29|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|52.26||||52.26|27.8|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|52.26||||52.26|29.79|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|52.26||||52.26|18.37|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|52.26||||52.26|28.74|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHFIRST [2395]|HEALTHFIRST [239500]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|52.26||||52.26|41.29|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|52.26||||52.26|14.79|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|52.26||||52.26|41.29|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|BENVEO/UCS [137512]|52.26||||52.26|27.8|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|52.26||||52.26|42.85|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|52.26||||52.26|23.52|44.42|13.83
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR CORE [203505]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA [126008]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|TULSA BLUE [115531]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA - ASA [141503]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|52.26||||52.26|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GILSBAR [1425]|GILSBAR [142500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GILSBAR [1425]|GILSBAR [142500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MEDICA [2910]|MEDICA QUEST [291001]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MEDICA [2910]|MEDICA QUEST [291001]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131501]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131501]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|52.26||||52.26|25.08|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|52.26||||52.26|25.08|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|52.26||||52.26|25.08|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|52.26||||52.26|44.42|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|52.26||||52.26|44.42|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|52.26||||52.26|44.42|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHFIRST [2395]|HEALTHFIRST [239500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHFIRST [2395]|HEALTHFIRST [239500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHFIRST [2395]|HEALTHFIRST [239500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131501]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MEDICA [2910]|MEDICA QUEST [291001]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|52.26||||52.26|36.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|52.26||||52.26|36.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|52.26||||52.26|36.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GILSBAR [1425]|GILSBAR [142500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|52.26||||52.26|23.52|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|52.26||||52.26|23.52|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|BENVEO/UCS [137512]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|BENVEO/UCS [137512]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|52.26||||52.26|14.79|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|52.26||||52.26|14.79|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|52.26||||52.26|14.79|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA [126008]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA [126008]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA [126008]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA - ASA [141503]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA - ASA [141503]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|52.26||||52.26|36.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|52.26||||52.26|36.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|52.26||||52.26|28.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|52.26||||52.26|28.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|52.26||||52.26|28.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|52.26||||52.26|29.79|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|52.26||||52.26|29.79|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|52.26||||52.26|29.79|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|52.26||||52.26|36.74|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|WEB TPA [2115]|WEB TPA [211500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|WEB TPA [2115]|WEB TPA [211500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|WEB TPA [2115]|WEB TPA [211500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|52.26||||52.26|23.52|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|52.26||||52.26|23.52|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|52.26||||52.26|23.52|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|52.26||||52.26|15.68|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|52.26||||52.26|15.68|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|52.26||||52.26|15.68|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.26||||52.26|13.83|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.26||||52.26|13.83|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|52.26||||52.26|13.83|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|BENVEO/UCS [137512]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|52.26||||52.26|23.52|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|52.26||||52.26|41.29|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|52.26||||52.26|18.13|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|52.26||||52.26|27.8|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|52.26||||52.26|42.85|44.42|13.83
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|TULSA BLUE [115531]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|TULSA BLUE [115531]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|TULSA BLUE [115531]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA - ASA [141503]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR CORE [203505]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR CORE [203505]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR CORE [203505]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|52.26||||52.26|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|52.26||||52.26|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|2080.00||||2080.00|1643.2|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|CIGNA [1260]|CIGNA [126008]|2080.00||||2080.00|873.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|2080.00||||2080.00|1768|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2080.00||||2080.00|998.4|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|CORESOURCE [1315]|CORESOURCE [131501]|2080.00||||2080.00|797.26|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MEDICA [2910]|MEDICA QUEST [291001]|2080.00||||2080.00|1106.56|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|GILSBAR [1425]|GILSBAR [142500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|TRUSTMARK [2030]|STARMARK [203000]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MULTIPLAN [1680]|IHC HS [168011]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|2080.00||||2080.00|1106.56|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2080.00||||2080.00|797.26|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|FMH BENEFIT SERVICES [1390]|FMH [139000]|2080.00||||2080.00|1643.2|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|AETNA [1015]|AETNA ACO WILCO [101532]|2080.00||||2080.00|797.26|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|<Self-pay>|<Self-pay>|2080.00||||2080.00|624|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2080.00||||2080.00|936|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2080.00||||2080.00|550.58|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|2080.00||||2080.00|1643.2|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2080.00||||2080.00|797.26|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2080.00||||2080.00|1643.2|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|WEB TPA [2115]|WEB TPA [211500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|2080.00||||2080.00|1144|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2080.00||||2080.00|1144|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2080.00||||2080.00|873.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHNET [1495]|HEALTHNET [149500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|2080.00||||2080.00|1643.2|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHFIRST [2395]|HEALTHFIRST [239500]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2080.00||||2080.00|588.64|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|2080.00||||2080.00|1705.6|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2080.00||||2080.00|1106.56|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2080.00||||2080.00|936|1768|550.58
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|UMR [2035]|UMR CORE [203505]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BCBS [1155]|TULSA BLUE [115531]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|GEHA [1415]|GEHA - ASA [141503]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|CHAMPVA [1240]|CHAMP VA [124000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|2080.00||||2080.00|||
100528|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ANCHOR SUTURE MULTIFIX 6.5MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2080.00||||2080.00|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.53||||12.53|5.64|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|12.53||||12.53|6.67|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.53||||12.53|3.55|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|12.53||||12.53|9.9|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.53||||12.53|6.89|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.53||||12.53|7.14|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|12.53||||12.53|9.9|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.53||||12.53|5.64|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|<Self-pay>|<Self-pay>|12.53||||12.53|3.76|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.53||||12.53|4.35|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.53||||12.53|3.32|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.53||||12.53|4.35|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12.53||||12.53|6.62|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|12.53||||12.53|9.9|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12.53||||12.53|9.9|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.53||||12.53|4.35|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|12.53||||12.53|6.67|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|12.53||||12.53|6.67|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.53||||12.53|4.35|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.53||||12.53|6.01|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|12.53||||12.53|9.9|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|12.53||||12.53|10.65|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|12.53||||12.53|10.27|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.53||||12.53|6.62|10.65|3.32
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR [2035]|UMR CORE [203505]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.53||||12.53|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.53||||12.53|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1729.00||||1729.00|1365.91|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|CIGNA [1260]|CIGNA [126008]|1729.00||||1729.00|726.18|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1729.00||||1729.00|1469.65|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|CORESOURCE [1315]|CORESOURCE [131501]|1729.00||||1729.00|662.73|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MEDICA [2910]|MEDICA QUEST [291001]|1729.00||||1729.00|919.83|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|GILSBAR [1425]|GILSBAR [142500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|TRUSTMARK [2030]|STARMARK [203000]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1729.00||||1729.00|919.83|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MULTIPLAN [1680]|IHC HS [168011]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1729.00||||1729.00|662.73|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|1729.00||||1729.00|1365.91|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|AETNA [1015]|AETNA ACO WILCO [101532]|1729.00||||1729.00|662.73|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|<Self-pay>|<Self-pay>|1729.00||||1729.00|518.7|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1729.00||||1729.00|778.05|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1729.00||||1729.00|1365.91|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1729.00||||1729.00|662.73|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1729.00||||1729.00|457.67|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1729.00||||1729.00|1365.91|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|WEB TPA [2115]|WEB TPA [211500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1729.00||||1729.00|950.95|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1729.00||||1729.00|950.95|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1729.00||||1729.00|726.18|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1729.00||||1729.00|829.92|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHNET [1495]|HEALTHNET [149500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1729.00||||1729.00|1365.91|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1729.00||||1729.00|489.31|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1729.00||||1729.00|919.83|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1729.00||||1729.00|1417.78|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1729.00||||1729.00|778.05|1469.65|457.67
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|UMR [2035]|UMR CORE [203505]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BCBS [1155]|TULSA BLUE [115531]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|GEHA [1415]|GEHA - ASA [141503]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|CHAMPVA [1240]|CHAMP VA [124000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1729.00||||1729.00|||
100596|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -3MM OFFSET TAPER 26MM HIP PRIMARY COCR V40 LFIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1729.00||||1729.00|778.05|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1729.00||||1729.00|489.31|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1729.00||||1729.00|1365.91|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1729.00||||1729.00|726.18|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1729.00||||1729.00|950.95|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1729.00||||1729.00|950.95|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1729.00||||1729.00|1365.91|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1729.00||||1729.00|778.05|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1729.00||||1729.00|662.73|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|<Self-pay>|<Self-pay>|1729.00||||1729.00|518.7|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|1729.00||||1729.00|662.73|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1729.00||||1729.00|457.67|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1729.00||||1729.00|1365.91|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1729.00||||1729.00|1365.91|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1729.00||||1729.00|662.73|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1729.00||||1729.00|919.83|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1729.00||||1729.00|919.83|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|GILSBAR [1425]|GILSBAR [142500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MEDICA [2910]|MEDICA QUEST [291001]|1729.00||||1729.00|919.83|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|CORESOURCE [1315]|CORESOURCE [131501]|1729.00||||1729.00|662.73|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1729.00||||1729.00|829.92|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1729.00||||1729.00|1469.65|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|CIGNA [1260]|CIGNA [126008]|1729.00||||1729.00|726.18|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1729.00||||1729.00|1417.78|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1729.00||||1729.00|1365.91|1469.65|457.67
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|TULSA BLUE [115531]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|UMR [2035]|UMR CORE [203505]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1729.00||||1729.00|||
100597|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR -4 MM OFFSET TAPER OD28 MM HIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1729.00||||1729.00|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|547.22||||547.22|432.3|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|CIGNA [1260]|CIGNA [126008]|547.22||||547.22|288.93|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|547.22||||547.22|465.14|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|547.22||||547.22|262.67|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|CORESOURCE [1315]|CORESOURCE [131501]|547.22||||547.22|189.88|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|GILSBAR [1425]|GILSBAR [142500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|TRUSTMARK [2030]|STARMARK [203000]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|547.22||||547.22|189.88|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|547.22||||547.22|291.12|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MULTIPLAN [1680]|IHC HS [168011]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|547.22||||547.22|432.3|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|FMH BENEFIT SERVICES [1390]|FMH [139000]|547.22||||547.22|432.3|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|547.22||||547.22|144.85|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|547.22||||547.22|246.25|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|547.22||||547.22|246.25|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|<Self-pay>|<Self-pay>|547.22||||547.22|164.17|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|AETNA [1015]|AETNA ACO WILCO [101532]|547.22||||547.22|189.88|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|547.22||||547.22|432.3|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|547.22||||547.22|189.88|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|WEB TPA [2115]|WEB TPA [211500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|547.22||||547.22|311.91|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|547.22||||547.22|300.97|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|547.22||||547.22|288.93|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MEDICA [2910]|MEDICA QUEST [291001]|547.22||||547.22|291.12|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHNET [1495]|HEALTHNET [149500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHFIRST [2395]|HEALTHFIRST [239500]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|547.22||||547.22|432.3|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|547.22||||547.22|154.86|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|FIRST HEALTH [1375]|BENVEO/UCS [137512]|547.22||||547.22|291.12|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|547.22||||547.22|448.72|465.14|144.85
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|UMR [2035]|UMR CORE [203505]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|TULSA BLUE [115531]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|GEHA [1415]|GEHA - ASA [141503]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|CHAMPVA [1240]|CHAMP VA [124000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|547.22||||547.22|||
100641|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|KIT SURGICAL TOTAL KNEE STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|547.22||||547.22|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|FIRST HEALTH [1375]|BENVEO/UCS [137512]|740.36||||740.36|393.87|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|740.36||||740.36|209.52|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|740.36||||740.36|584.88|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHNET [1495]|HEALTHNET [149500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|740.36||||740.36|390.91|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|740.36||||740.36|407.2|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|740.36||||740.36|422.01|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|740.36||||740.36|256.9|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|740.36||||740.36|584.88|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|WEB TPA [2115]|WEB TPA [211500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|740.36||||740.36|333.16|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|740.36||||740.36|333.16|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|<Self-pay>|<Self-pay>|740.36||||740.36|222.11|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|AETNA [1015]|AETNA ACO WILCO [101532]|740.36||||740.36|256.9|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|740.36||||740.36|195.97|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|FMH BENEFIT SERVICES [1390]|FMH [139000]|740.36||||740.36|584.88|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|740.36||||740.36|584.88|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|740.36||||740.36|393.87|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MULTIPLAN [1680]|IHC HS [168011]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|740.36||||740.36|256.9|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|TRUSTMARK [2030]|STARMARK [203000]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|GILSBAR [1425]|GILSBAR [142500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MEDICA [2910]|MEDICA QUEST [291001]|740.36||||740.36|393.87|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|CORESOURCE [1315]|CORESOURCE [131501]|740.36||||740.36|256.9|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|740.36||||740.36|355.37|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|740.36||||740.36|629.31|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|CIGNA [1260]|CIGNA [126008]|740.36||||740.36|390.91|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHFIRST [2395]|HEALTHFIRST [239500]|740.36||||740.36|607.1|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|740.36||||740.36|584.88|629.31|195.97
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|CHAMPVA [1240]|CHAMP VA [124000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|GEHA [1415]|GEHA - ASA [141503]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|TULSA BLUE [115531]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|UMR [2035]|UMR CORE [203505]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|740.36||||740.36|||
100642|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL TOTAL HIP STERILE DISPOSABLE BAILEY MEDICAL CENTER|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|740.36||||740.36|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|142.27||||142.27|112.39|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHFIRST [2395]|HEALTHFIRST [239500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|CIGNA [1260]|CIGNA [126008]|142.27||||142.27|75.12|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|142.27||||142.27|120.93|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|142.27||||142.27|68.29|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|CORESOURCE [1315]|CORESOURCE [131501]|142.27||||142.27|49.37|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|GILSBAR [1425]|GILSBAR [142500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|TRUSTMARK [2030]|STARMARK [203000]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|142.27||||142.27|49.37|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|142.27||||142.27|75.69|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MULTIPLAN [1680]|IHC HS [168011]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|142.27||||142.27|112.39|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|FMH BENEFIT SERVICES [1390]|FMH [139000]|142.27||||142.27|112.39|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|142.27||||142.27|37.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|AETNA [1015]|AETNA ACO WILCO [101532]|142.27||||142.27|49.37|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|<Self-pay>|<Self-pay>|142.27||||142.27|42.68|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|142.27||||142.27|64.02|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|142.27||||142.27|64.02|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|142.27||||142.27|112.39|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|142.27||||142.27|49.37|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|WEB TPA [2115]|WEB TPA [211500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|142.27||||142.27|81.1|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|142.27||||142.27|78.25|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|142.27||||142.27|75.12|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MEDICA [2910]|MEDICA QUEST [291001]|142.27||||142.27|75.69|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHNET [1495]|HEALTHNET [149500]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|142.27||||142.27|112.39|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|142.27||||142.27|40.26|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|FIRST HEALTH [1375]|BENVEO/UCS [137512]|142.27||||142.27|75.69|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|142.27||||142.27|116.66|120.93|37.66
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|UMR [2035]|UMR CORE [203505]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BCBS [1155]|TULSA BLUE [115531]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|GEHA [1415]|GEHA - ASA [141503]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|CHAMPVA [1240]|CHAMP VA [124000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|142.27||||142.27|||
100643|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL CYSTO BAILEY MEDICAL CENTER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|142.27||||142.27|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1015.66||||1015.66|540.33|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1015.66||||1015.66|457.05|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1015.66||||1015.66|287.43|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1015.66||||1015.66|802.37|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHNET [1495]|HEALTHNET [149500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1015.66||||1015.66|426.58|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1015.66||||1015.66|558.62|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1015.66||||1015.66|558.62|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|WEB TPA [2115]|WEB TPA [211500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1015.66||||1015.66|802.37|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1015.66||||1015.66|457.05|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|<Self-pay>|<Self-pay>|1015.66||||1015.66|304.7|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1015.66||||1015.66|268.85|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1015.66||||1015.66|802.37|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1015.66||||1015.66|802.37|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MULTIPLAN [1680]|IHC HS [168011]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1015.66||||1015.66|540.33|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|TRUSTMARK [2030]|STARMARK [203000]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GILSBAR [1425]|GILSBAR [142500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MEDICA [2910]|MEDICA QUEST [291001]|1015.66||||1015.66|540.33|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1015.66||||1015.66|487.52|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1015.66||||1015.66|863.31|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|CIGNA [1260]|CIGNA [126008]|1015.66||||1015.66|426.58|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1015.66||||1015.66|832.84|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1015.66||||1015.66|802.37|863.31|268.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|CHAMPVA [1240]|CHAMP VA [124000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|TULSA BLUE [115531]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AETNA [1015]|AETNA ACO WILCO [101532]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UMR [2035]|UMR CORE [203505]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GEHA [1415]|GEHA - ASA [141503]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|CORESOURCE [1315]|CORESOURCE [131501]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1015.66||||1015.66|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1015.66||||1015.66|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|24149.02||||24149.02|19077.72|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|CIGNA [1260]|CIGNA [126008]|24149.02||||24149.02|10142.59|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|24149.02||||24149.02|20526.66|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|24149.02||||24149.02|11591.53|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131501]|24149.02||||24149.02|9256.32|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MEDICA [2910]|MEDICA QUEST [291001]|24149.02||||24149.02|12847.28|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|GILSBAR [1425]|GILSBAR [142500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|24149.02||||24149.02|9256.32|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MULTIPLAN [1680]|IHC HS [168011]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|24149.02||||24149.02|12847.28|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|24149.02||||24149.02|19077.72|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|24149.02||||24149.02|19077.72|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24149.02||||24149.02|6392.24|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|<Self-pay>|<Self-pay>|24149.02||||24149.02|7244.71|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|24149.02||||24149.02|10867.06|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|24149.02||||24149.02|10867.06|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|24149.02||||24149.02|19077.72|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|24149.02||||24149.02|9256.32|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|24149.02||||24149.02|9256.32|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|24149.02||||24149.02|13281.96|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|24149.02||||24149.02|13281.96|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|24149.02||||24149.02|10142.59|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|24149.02||||24149.02|19077.72|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|24149.02||||24149.02|6834.17|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|24149.02||||24149.02|12847.28|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|24149.02||||24149.02|19802.19|20526.66|6392.24
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|UMR [2035]|UMR CORE [203505]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|TULSA BLUE [115531]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|GEHA [1415]|GEHA - ASA [141503]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|24149.02||||24149.02|||
100781|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 6 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24149.02||||24149.02|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|977.60||||977.60|276.66|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|977.60||||977.60|772.3|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHNET [1495]|HEALTHNET [149500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|977.60||||977.60|410.59|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|977.60||||977.60|537.68|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|WEB TPA [2115]|WEB TPA [211500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|977.60||||977.60|772.3|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|977.60||||977.60|439.92|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|977.60||||977.60|439.92|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|<Self-pay>|<Self-pay>|977.60||||977.60|293.28|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|977.60||||977.60|537.68|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|977.60||||977.60|258.77|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|FMH BENEFIT SERVICES [1390]|FMH [139000]|977.60||||977.60|772.3|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|977.60||||977.60|772.3|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|977.60||||977.60|520.08|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MULTIPLAN [1680]|IHC HS [168011]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|977.60||||977.60|520.08|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|TRUSTMARK [2030]|STARMARK [203000]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|GILSBAR [1425]|GILSBAR [142500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MEDICA [2910]|MEDICA QUEST [291001]|977.60||||977.60|520.08|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|977.60||||977.60|469.25|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|977.60||||977.60|830.96|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|CIGNA [1260]|CIGNA [126008]|977.60||||977.60|410.59|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|977.60||||977.60|801.63|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|977.60||||977.60|772.3|830.96|258.77
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|CHAMPVA [1240]|CHAMP VA [124000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BCBS [1155]|TULSA BLUE [115531]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|AETNA [1015]|AETNA ACO WILCO [101532]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|UMR [2035]|UMR CORE [203505]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|GEHA [1415]|GEHA - ASA [141503]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|CORESOURCE [1315]|CORESOURCE [131501]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|977.60||||977.60|||
100840|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE T10 L28 MM OD4.1 MM LAG CROSS PLATE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|977.60||||977.60|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1729.00||||1729.00|1365.91|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|CIGNA [1260]|CIGNA [126008]|1729.00||||1729.00|726.18|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1729.00||||1729.00|1469.65|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|CORESOURCE [1315]|CORESOURCE [131501]|1729.00||||1729.00|662.73|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MEDICA [2910]|MEDICA QUEST [291001]|1729.00||||1729.00|919.83|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GILSBAR [1425]|GILSBAR [142500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1729.00||||1729.00|919.83|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1729.00||||1729.00|662.73|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1729.00||||1729.00|1365.91|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|FMH BENEFIT SERVICES [1390]|FMH [139000]|1729.00||||1729.00|1365.91|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|1729.00||||1729.00|662.73|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|<Self-pay>|<Self-pay>|1729.00||||1729.00|518.7|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1729.00||||1729.00|778.05|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1729.00||||1729.00|457.67|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1729.00||||1729.00|1365.91|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1729.00||||1729.00|662.73|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1729.00||||1729.00|950.95|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1729.00||||1729.00|950.95|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1729.00||||1729.00|726.18|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1729.00||||1729.00|829.92|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1729.00||||1729.00|1365.91|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1729.00||||1729.00|489.31|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1729.00||||1729.00|1417.78|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1729.00||||1729.00|919.83|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1729.00||||1729.00|778.05|1469.65|457.67
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UMR [2035]|UMR CORE [203505]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|TULSA BLUE [115531]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6204.25||||6204.25|3300.66|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHNET [1495]|HEALTHNET [149500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6204.25||||6204.25|2605.79|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6204.25||||6204.25|3412.34|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|6204.25||||6204.25|3412.34|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|WEB TPA [2115]|WEB TPA [211500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6204.25||||6204.25|2378.09|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|6204.25||||6204.25|4901.36|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6204.25||||6204.25|2791.91|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6204.25||||6204.25|2791.91|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|<Self-pay>|<Self-pay>|6204.25||||6204.25|1861.27|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AETNA [1015]|AETNA ACO WILCO [101532]|6204.25||||6204.25|2378.09|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6204.25||||6204.25|1642.26|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|6204.25||||6204.25|4901.36|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6204.25||||6204.25|4901.36|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MULTIPLAN [1680]|IHC HS [168011]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|6204.25||||6204.25|3300.66|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6204.25||||6204.25|2378.09|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|6204.25||||6204.25|4901.36|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6204.25||||6204.25|1755.8|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|TRUSTMARK [2030]|STARMARK [203000]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GILSBAR [1425]|GILSBAR [142500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MEDICA [2910]|MEDICA QUEST [291001]|6204.25||||6204.25|3300.66|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CORESOURCE [1315]|CORESOURCE [131501]|6204.25||||6204.25|2378.09|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6204.25||||6204.25|2978.04|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|6204.25||||6204.25|5273.61|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CIGNA [1260]|CIGNA [126008]|6204.25||||6204.25|2605.79|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHFIRST [2395]|HEALTHFIRST [239500]|6204.25||||6204.25|5087.49|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|6204.25||||6204.25|4901.36|5273.61|1642.26
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CHAMPVA [1240]|CHAMP VA [124000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GEHA [1415]|GEHA - ASA [141503]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|TULSA BLUE [115531]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UMR [2035]|UMR CORE [203505]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6204.25||||6204.25|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1534.00||||1534.00|1211.86|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|CIGNA [1260]|CIGNA [126008]|1534.00||||1534.00|644.28|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1534.00||||1534.00|1303.9|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1534.00||||1534.00|736.32|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|CORESOURCE [1315]|CORESOURCE [131501]|1534.00||||1534.00|587.98|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|GILSBAR [1425]|GILSBAR [142500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|TRUSTMARK [2030]|STARMARK [203000]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MULTIPLAN [1680]|IHC HS [168011]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1534.00||||1534.00|816.09|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1534.00||||1534.00|1211.86|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|FMH BENEFIT SERVICES [1390]|FMH [139000]|1534.00||||1534.00|1211.86|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1534.00||||1534.00|406.05|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|AETNA [1015]|AETNA ACO WILCO [101532]|1534.00||||1534.00|587.98|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|<Self-pay>|<Self-pay>|1534.00||||1534.00|460.2|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1534.00||||1534.00|690.3|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1534.00||||1534.00|690.3|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1534.00||||1534.00|1211.86|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1534.00||||1534.00|587.98|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|WEB TPA [2115]|WEB TPA [211500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1534.00||||1534.00|843.7|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1534.00||||1534.00|843.7|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1534.00||||1534.00|587.98|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1534.00||||1534.00|644.28|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MEDICA [2910]|MEDICA QUEST [291001]|1534.00||||1534.00|816.09|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHNET [1495]|HEALTHNET [149500]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1534.00||||1534.00|1211.86|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1534.00||||1534.00|434.12|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1534.00||||1534.00|816.09|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1534.00||||1534.00|1257.88|1303.9|406.05
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|UMR [2035]|UMR CORE [203505]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BCBS [1155]|TULSA BLUE [115531]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|GEHA [1415]|GEHA - ASA [141503]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|CHAMPVA [1240]|CHAMP VA [124000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1534.00||||1534.00|||
100909|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PROSTHESIS NASAL BLOM SINGER OVAL L13 MM X W11 MM X H2 MM SEPTAL PERFORATION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1534.00||||1534.00|816.09|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1534.00||||1534.00|434.12|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHNET [1495]|HEALTHNET [149500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1534.00||||1534.00|644.28|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1534.00||||1534.00|843.7|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|WEB TPA [2115]|WEB TPA [211500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1534.00||||1534.00|587.98|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1534.00||||1534.00|1211.86|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1534.00||||1534.00|690.3|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1534.00||||1534.00|690.3|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|<Self-pay>|<Self-pay>|1534.00||||1534.00|460.2|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1534.00||||1534.00|843.7|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|AETNA [1015]|AETNA ACO WILCO [101532]|1534.00||||1534.00|587.98|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1534.00||||1534.00|406.05|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|FMH BENEFIT SERVICES [1390]|FMH [139000]|1534.00||||1534.00|1211.86|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1534.00||||1534.00|1211.86|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MULTIPLAN [1680]|IHC HS [168011]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1534.00||||1534.00|816.09|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1534.00||||1534.00|587.98|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1534.00||||1534.00|1211.86|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|TRUSTMARK [2030]|STARMARK [203000]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|GILSBAR [1425]|GILSBAR [142500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MEDICA [2910]|MEDICA QUEST [291001]|1534.00||||1534.00|816.09|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|CORESOURCE [1315]|CORESOURCE [131501]|1534.00||||1534.00|587.98|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1534.00||||1534.00|736.32|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1534.00||||1534.00|1303.9|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|CIGNA [1260]|CIGNA [126008]|1534.00||||1534.00|644.28|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1534.00||||1534.00|1257.88|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1534.00||||1534.00|1211.86|1303.9|406.05
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|CHAMPVA [1240]|CHAMP VA [124000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BCBS [1155]|TULSA BLUE [115531]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|UMR [2035]|UMR CORE [203505]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|GEHA [1415]|GEHA - ASA [141503]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1534.00||||1534.00|||
100910|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 13X17|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1534.00||||1534.00|1211.86|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|CIGNA [1260]|CIGNA [126008]|1534.00||||1534.00|644.28|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1534.00||||1534.00|1303.9|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1534.00||||1534.00|736.32|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|CORESOURCE [1315]|CORESOURCE [131501]|1534.00||||1534.00|587.98|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|GILSBAR [1425]|GILSBAR [142500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|TRUSTMARK [2030]|STARMARK [203000]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MULTIPLAN [1680]|IHC HS [168011]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1534.00||||1534.00|816.09|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1534.00||||1534.00|1211.86|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|FMH BENEFIT SERVICES [1390]|FMH [139000]|1534.00||||1534.00|1211.86|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1534.00||||1534.00|406.05|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|<Self-pay>|<Self-pay>|1534.00||||1534.00|460.2|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1534.00||||1534.00|690.3|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1534.00||||1534.00|690.3|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|AETNA [1015]|AETNA ACO WILCO [101532]|1534.00||||1534.00|587.98|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1534.00||||1534.00|1211.86|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1534.00||||1534.00|587.98|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|WEB TPA [2115]|WEB TPA [211500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1534.00||||1534.00|843.7|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1534.00||||1534.00|587.98|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1534.00||||1534.00|843.7|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1534.00||||1534.00|644.28|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MEDICA [2910]|MEDICA QUEST [291001]|1534.00||||1534.00|816.09|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHNET [1495]|HEALTHNET [149500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1534.00||||1534.00|1211.86|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1534.00||||1534.00|434.12|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1534.00||||1534.00|816.09|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1534.00||||1534.00|1257.88|1303.9|406.05
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|UMR [2035]|UMR CORE [203505]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BCBS [1155]|TULSA BLUE [115531]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|GEHA [1415]|GEHA - ASA [141503]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|CHAMPVA [1240]|CHAMP VA [124000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1534.00||||1534.00|||
100911|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BUTTON SEPTAL OVAL 2MM 15X21|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1534.00||||1534.00|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|3733.34||||3733.34|1986.14|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3733.34||||3733.34|1056.54|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHNET [1495]|HEALTHNET [149500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3733.34||||3733.34|1568|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3733.34||||3733.34|2053.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|WEB TPA [2115]|WEB TPA [211500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3733.34||||3733.34|1430.99|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|3733.34||||3733.34|2949.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3733.34||||3733.34|1680|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3733.34||||3733.34|1680|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|<Self-pay>|<Self-pay>|3733.34||||3733.34|1120|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3733.34||||3733.34|2053.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|3733.34||||3733.34|1430.99|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3733.34||||3733.34|988.22|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3733.34||||3733.34|2949.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|3733.34||||3733.34|2949.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3733.34||||3733.34|1430.99|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MULTIPLAN [1680]|IHC HS [168011]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|3733.34||||3733.34|1986.14|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|3733.34||||3733.34|2949.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|TRUSTMARK [2030]|STARMARK [203000]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|GILSBAR [1425]|GILSBAR [142500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MEDICA [2910]|MEDICA QUEST [291001]|3733.34||||3733.34|1986.14|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|3733.34||||3733.34|1430.99|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3733.34||||3733.34|1792|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|3733.34||||3733.34|3173.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|CIGNA [1260]|CIGNA [126008]|3733.34||||3733.34|1568|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|3733.34||||3733.34|3061.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|3733.34||||3733.34|2949.34|3173.34|988.22
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|UMR [2035]|UMR CORE [203505]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3733.34||||3733.34|||
100926|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE BONE VARIAX L120 MM CLAVICLE RIGHT SUPERIOR 8 HOLE INCREASE CURVATURE BRIDGE NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3733.34||||3733.34|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1872.69||||1872.69|1479.42|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|CIGNA [1260]|CIGNA [126008]|1872.69||||1872.69|988.78|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1872.69||||1872.69|1591.78|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1872.69||||1872.69|898.89|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|CORESOURCE [1315]|CORESOURCE [131501]|1872.69||||1872.69|649.82|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MEDICA [2910]|MEDICA QUEST [291001]|1872.69||||1872.69|996.27|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|GILSBAR [1425]|GILSBAR [142500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|TRUSTMARK [2030]|STARMARK [203000]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1872.69||||1872.69|996.27|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MULTIPLAN [1680]|IHC HS [168011]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1872.69||||1872.69|649.82|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1872.69||||1872.69|1479.42|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|FMH BENEFIT SERVICES [1390]|FMH [139000]|1872.69||||1872.69|1479.42|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1872.69||||1872.69|495.7|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|<Self-pay>|<Self-pay>|1872.69||||1872.69|561.81|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1872.69||||1872.69|842.71|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1872.69||||1872.69|842.71|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1872.69||||1872.69|1479.42|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1872.69||||1872.69|649.82|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|1872.69||||1872.69|649.82|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|WEB TPA [2115]|WEB TPA [211500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1872.69||||1872.69|1067.43|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1872.69||||1872.69|1029.98|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1872.69||||1872.69|988.78|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHNET [1495]|HEALTHNET [149500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1872.69||||1872.69|1479.42|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1872.69||||1872.69|529.97|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1872.69||||1872.69|996.27|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1872.69||||1872.69|1535.6|1591.78|495.7
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|UMR [2035]|UMR CORE [203505]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BCBS [1155]|TULSA BLUE [115531]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|GEHA [1415]|GEHA - ASA [141503]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1872.69||||1872.69|||
100974|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SEEKER SURGICAL NUVENT L7 MM OD7 MM MAXILLARY SINUS ELECTROMAGNETIC BALLOON STERILE DISPOSABLE COMPUTER ASSIST SURGERY SYSTEM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1872.69||||1872.69|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|77.16||||77.16|2.21|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|77.16||||77.16|60.96|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|77.16||||77.16|65.59|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CORESOURCE [1315]|CORESOURCE [131501]|77.16||||77.16|26.77|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MEDICA [2910]|MEDICA QUEST [291001]|77.16||||77.16|41.05|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GILSBAR [1425]|GILSBAR [142500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|TRUSTMARK [2030]|STARMARK [203000]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|77.16||||77.16|26.77|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|IHC HS [168011]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|77.16||||77.16|41.05|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|77.16||||77.16|60.96|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FMH BENEFIT SERVICES [1390]|FMH [139000]|77.16||||77.16|60.96|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|77.16||||77.16|26.77|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|77.16||||77.16|23.15|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|77.16||||77.16|34.72|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|77.16||||77.16|20.42|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|77.16||||77.16|60.96|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|77.16||||77.16|26.77|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|WEB TPA [2115]|WEB TPA [211500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|77.16||||77.16|43.98|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|77.16||||77.16|42.44|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|77.16||||77.16|2.21|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|77.16||||77.16|37.04|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHFIRST [2395]|HEALTHFIRST [239500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHNET [1495]|HEALTHNET [149500]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|77.16||||77.16|60.96|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|77.16||||77.16|21.84|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|77.16||||77.16|34.72|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|77.16||||77.16|63.27|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|BENVEO/UCS [137512]|77.16||||77.16|41.05|65.59|2.21
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA [126008]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UMR CORE [203505]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|TULSA BLUE [115531]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA - ASA [141503]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|77.16||||77.16|||
10106|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|GENTAMICIN 80 MG/100 ML IN SODIUM CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|77.16||||77.16|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6.88||||6.88|1.95|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHNET [1495]|HEALTHNET [149500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6.88||||6.88|3.78|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|6.88||||6.88|3.92|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6.88||||6.88|2.39|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|6.88||||6.88|5.43|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|WEB TPA [2115]|WEB TPA [211500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6.88||||6.88|3.09|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6.88||||6.88|3.09|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|<Self-pay>|<Self-pay>|6.88||||6.88|2.07|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|6.88||||6.88|2.39|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.88||||6.88|1.82|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6.88||||6.88|5.43|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6.88||||6.88|3.63|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6.88||||6.88|5.43|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|IHC HS [168011]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|6.88||||6.88|3.66|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6.88||||6.88|2.39|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|6.88||||6.88|5.43|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6.88||||6.88|3.66|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|TRUSTMARK [2030]|STARMARK [203000]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GILSBAR [1425]|GILSBAR [142500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MEDICA [2910]|MEDICA QUEST [291001]|6.88||||6.88|3.66|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|6.88||||6.88|2.39|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6.88||||6.88|3.3|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|6.88||||6.88|5.84|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|6.88||||6.88|3.63|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|6.88||||6.88|5.64|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|6.88||||6.88|5.43|5.84|1.82
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6.88||||6.88|||
101140|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL SOURCEMARK STANDARD ID7.0 MM NASAL ORAL CYLINDRICAL CUFF MURPHY EYE FULL LENGTH XRAY OPAQUE STRIP PILOT BALLOON STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHNET [1495]|HEALTHNET [149500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|6.88||||6.88|5.43|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6.88||||6.88|1.95|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|6.88||||6.88|3.66|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6.88||||6.88|3.63|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6.88||||6.88|3.78|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|6.88||||6.88|3.66|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6.88||||6.88|3.09|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GILSBAR [1425]|GILSBAR [142500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|TRUSTMARK [2030]|STARMARK [203000]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|6.88||||6.88|3.92|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|6.88||||6.88|5.43|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|<Self-pay>|<Self-pay>|6.88||||6.88|2.07|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|6.88||||6.88|5.43|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|6.88||||6.88|3.63|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6.88||||6.88|2.39|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6.88||||6.88|2.39|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|6.88||||6.88|5.43|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|6.88||||6.88|2.39|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|IHC HS [168011]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MEDICA [2910]|MEDICA QUEST [291001]|6.88||||6.88|3.66|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6.88||||6.88|3.09|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.88||||6.88|1.82|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|6.88||||6.88|2.39|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6.88||||6.88|3.3|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6.88||||6.88|5.43|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|WEB TPA [2115]|WEB TPA [211500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|6.88||||6.88|5.84|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6.88||||6.88|5.64|5.84|1.82
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|6.88||||6.88|||
101141|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBE ENDOTRACHEAL ID7.5 MM NASAL ORAL CUFF MURPHY STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6.88||||6.88|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.49||||5.49|1.91|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.49||||5.49|3.13|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|CIGNA [1260]|CIGNA [126008]|5.49||||5.49|2.9|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.49||||5.49|4.34|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.49||||5.49|4.34|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.49||||5.49|1.91|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.49||||5.49|2.92|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|5.49||||5.49|2.92|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.49||||5.49|2.9|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|5.49||||5.49|1.91|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|5.49||||5.49|1.91|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.49||||5.49|2.47|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.49||||5.49|4.67|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.49||||5.49|1.55|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.49||||5.49|2.64|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.49||||5.49|1.45|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.49||||5.49|3.02|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.49||||5.49|2.92|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.49||||5.49|4.34|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.49||||5.49|4.34|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.49||||5.49|2.47|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|<Self-pay>|<Self-pay>|5.49||||5.49|1.65|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.49||||5.49|4.34|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.49||||5.49|4.5|4.67|1.45
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|UMR [2035]|UMR CORE [203505]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.49||||5.49|||
10116|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 10 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.49||||5.49|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|60.42||||60.42|27.19|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|60.42||||60.42|29|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|60.42||||60.42|20.97|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MEDICA [2910]|MEDICA QUEST [291001]|60.42||||60.42|32.15|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GILSBAR [1425]|GILSBAR [142500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|TRUSTMARK [2030]|STARMARK [203000]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|60.42||||60.42|15.99|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MULTIPLAN [1680]|IHC HS [168011]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|60.42||||60.42|20.97|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|60.42||||60.42|47.73|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|60.42||||60.42|20.97|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|60.42||||60.42|47.73|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|60.42||||60.42|47.73|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHNET [1495]|HEALTHNET [149500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|WEB TPA [2115]|WEB TPA [211500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|60.42||||60.42|47.73|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|60.42||||60.42|32.15|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|60.42||||60.42|34.44|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|60.42||||60.42|33.23|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|60.42||||60.42|27.19|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|60.42||||60.42|31.9|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|60.42||||60.42|47.73|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|60.42||||60.42|51.36|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|60.42||||60.42|32.15|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|60.42||||60.42|17.1|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|CIGNA [1260]|CIGNA [126008]|60.42||||60.42|31.9|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|60.42||||60.42|20.97|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|<Self-pay>|<Self-pay>|60.42||||60.42|18.12|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|60.42||||60.42|49.55|51.36|15.99
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UMR [2035]|UMR CORE [203505]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|CHAMPVA [1240]|CHAMP VA [124000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|60.42||||60.42|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|60.42||||60.42|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|9.45||||9.45|5.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|9.45||||9.45|4.99|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9.45||||9.45|4.54|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MEDICA [2910]|MEDICA QUEST [291001]|9.45||||9.45|5.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|9.45||||9.45|8.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|9.45||||9.45|8.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|9.45||||9.45|5.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|9.45||||9.45|4.25|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|9.45||||9.45|2.67|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|9.45||||9.45|4.99|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|9.45||||9.45|5.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|9.45||||9.45|4.25|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|9.45||||9.45|5.2|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|9.45||||9.45|5.39|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|9.45||||9.45|5.2|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9.45||||9.45|2.5|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|9.45||||9.45|4.99|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|9.45||||9.45|4.99|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|9.45||||9.45|5.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|9.45||||9.45|5.39|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|<Self-pay>|<Self-pay>|9.45||||9.45|2.83|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|<Self-pay>|<Self-pay>|9.45||||9.45|2.83|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|9.45||||9.45|4.25|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|9.45||||9.45|4.25|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|9.45||||9.45|2.67|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9.45||||9.45|4.54|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9.45||||9.45|2.5|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FIRST HEALTH [1375]|BENVEO/UCS [137512]|9.45||||9.45|5.03|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9.45||||9.45|3.28|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9.45||||9.45|7.75|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|9.45||||9.45|7.47|8.03|2.5
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|9.45||||9.45|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|9.45||||9.45|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|GILSBAR [1425]|GILSBAR [142500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1572.48||||1572.48|1336.61|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1572.48||||1572.48|1242.26|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1572.48||||1572.48|754.79|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|CIGNA [1260]|CIGNA [126008]|1572.48||||1572.48|660.44|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1572.48||||1572.48|1242.26|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1572.48||||1572.48|416.24|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1572.48||||1572.48|707.62|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1572.48||||1572.48|1242.26|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|1572.48||||1572.48|602.73|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1572.48||||1572.48|660.44|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1572.48||||1572.48|864.86|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|1572.48||||1572.48|602.73|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1572.48||||1572.48|836.56|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1572.48||||1572.48|1242.26|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|WEB TPA [2115]|WEB TPA [211500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MEDICA [2910]|MEDICA QUEST [291001]|1572.48||||1572.48|836.56|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MULTIPLAN [1680]|IHC HS [168011]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1572.48||||1572.48|602.73|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1572.48||||1572.48|602.73|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHNET [1495]|HEALTHNET [149500]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1572.48||||1572.48|864.86|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|<Self-pay>|<Self-pay>|1572.48||||1572.48|471.74|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|TRUSTMARK [2030]|STARMARK [203000]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1572.48||||1572.48|707.62|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1572.48||||1572.48|1242.26|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1572.48||||1572.48|836.56|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1572.48||||1572.48|445.01|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1572.48||||1572.48|1289.43|1336.61|416.24
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|UMR [2035]|UMR CORE [203505]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1572.48||||1572.48|||
101241|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 4MM 40MM FIXOS TITANIUM MIDFOOT REARFOOT COMPRESSION HEADLESS NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1572.48||||1572.48|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|FMH BENEFIT SERVICES [1390]|FMH [139000]|929.60||||929.60|734.38|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|929.60||||929.60|322.57|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|929.60||||929.60|494.55|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|929.60||||929.60|734.38|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MULTIPLAN [1680]|IHC HS [168011]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|929.60||||929.60|246.07|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MEDICA [2910]|MEDICA QUEST [291001]|929.60||||929.60|494.55|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|929.60||||929.60|446.21|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|929.60||||929.60|790.16|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|929.60||||929.60|734.38|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|<Self-pay>|<Self-pay>|929.60||||929.60|278.88|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GILSBAR [1425]|GILSBAR [142500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|CORESOURCE [1315]|CORESOURCE [131501]|929.60||||929.60|322.57|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|CIGNA [1260]|CIGNA [126008]|929.60||||929.60|490.83|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AETNA [1015]|AETNA ACO WILCO [101532]|929.60||||929.60|322.57|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|TRUSTMARK [2030]|STARMARK [203000]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|FIRST HEALTH [1375]|BENVEO/UCS [137512]|929.60||||929.60|494.55|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|929.60||||929.60|418.32|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|929.60||||929.60|734.38|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHNET [1495]|HEALTHNET [149500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|929.60||||929.60|418.32|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|929.60||||929.60|263.08|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|929.60||||929.60|490.83|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|929.60||||929.60|734.38|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|929.60||||929.60|511.28|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|WEB TPA [2115]|WEB TPA [211500]|929.60||||929.60|762.27|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|929.60||||929.60|529.87|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|929.60||||929.60|322.57|790.16|246.07
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UMR [2035]|UMR CORE [203505]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|CHAMPVA [1240]|CHAMP VA [124000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GEHA [1415]|GEHA - ASA [141503]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|TULSA BLUE [115531]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|929.60||||929.60|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|0.94||||0.94|0.74|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|CIGNA [1260]|CIGNA [126008]|0.94||||0.94|0.5|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|CORESOURCE [1315]|CORESOURCE [131501]|0.94||||0.94|0.33|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|GILSBAR [1425]|GILSBAR [142500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|TRUSTMARK [2030]|STARMARK [203000]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MEDICA [2910]|MEDICA QUEST [291001]|0.94||||0.94|0.5|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|0.94||||0.94|0.45|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MULTIPLAN [1680]|IHC HS [168011]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|0.94||||0.94|0.33|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|0.94||||0.94|0.42|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.94||||0.94|0.25|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|0.94||||0.94|0.33|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|0.94||||0.94|0.74|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|WEB TPA [2115]|WEB TPA [211500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|0.94||||0.94|0.53|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|0.94||||0.94|0.5|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|0.94||||0.94|0.5|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|0.94||||0.94|0.74|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|0.94||||0.94|0.52|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|0.94||||0.94|0.8|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|0.94||||0.94|0.33|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHNET [1495]|HEALTHNET [149500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|0.94||||0.94|0.42|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|0.94||||0.94|0.27|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|<Self-pay>|<Self-pay>|0.94||||0.94|0.28|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|0.94||||0.94|0.74|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|0.94||||0.94|0.74|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|0.94||||0.94|0.5|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.94||||0.94|0.77|0.8|0.25
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|UMR [2035]|UMR CORE [203505]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|GEHA [1415]|GEHA - ASA [141503]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|CHAMPVA [1240]|CHAMP VA [124000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|0.94||||0.94|||
101331|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SOLUTION INHALATION ADDIPAK 0.9% SALINE 15 ML UNIT DOSE RED VIAL STERILE|BCBS [1155]|TULSA BLUE [115531]|0.94||||0.94|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|5.88||||5.88|3.13|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.88||||5.88|2.64|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.88||||5.88|1.66|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|5.88||||5.88|4.64|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHNET [1495]|HEALTHNET [149500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5.88||||5.88|3.1|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.88||||5.88|3.23|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.88||||5.88|2.04|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|WEB TPA [2115]|WEB TPA [211500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|<Self-pay>|<Self-pay>|5.88||||5.88|1.77|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|5.88||||5.88|2.04|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|5.88||||5.88|4.64|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MULTIPLAN [1680]|IHC HS [168011]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|5.88||||5.88|4.64|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.88||||5.88|3.35|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.88||||5.88|2.04|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|5.88||||5.88|3.13|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.88||||5.88|1.56|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5.88||||5.88|4.64|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.88||||5.88|2.64|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GILSBAR [1425]|GILSBAR [142500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MEDICA [2910]|MEDICA QUEST [291001]|5.88||||5.88|3.13|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|5.88||||5.88|4.64|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.88||||5.88|2.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|5.88||||5.88|2.04|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|CIGNA [1260]|CIGNA [126008]|5.88||||5.88|3.1|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|TRUSTMARK [2030]|STARMARK [203000]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|5.88||||5.88|4.99|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5.88||||5.88|4.82|4.99|1.56
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|CHAMPVA [1240]|CHAMP VA [124000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UMR [2035]|UMR CORE [203505]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.88||||5.88|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.56||||1.56|0.54|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|CIGNA [1260]|CIGNA [126008]|1.56||||1.56|0.83|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|TRUSTMARK [2030]|STARMARK [203000]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|1.56||||1.56|1.23|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|1.56||||1.56|1.33|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|1.56||||1.56|0.54|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MEDICA [2910]|MEDICA QUEST [291001]|1.56||||1.56|0.83|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.56||||1.56|0.75|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|1.56||||1.56|0.83|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|1.56||||1.56|1.23|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MULTIPLAN [1680]|IHC HS [168011]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1.56||||1.56|1.23|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1.56||||1.56|0.7|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.56||||1.56|1.23|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|1.56||||1.56|0.54|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.56||||1.56|0.41|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1.56||||1.56|0.7|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.56||||1.56|0.54|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1.56||||1.56|0.89|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.56||||1.56|0.83|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1.56||||1.56|0.86|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|WEB TPA [2115]|WEB TPA [211500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|GILSBAR [1425]|GILSBAR [142500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHNET [1495]|HEALTHNET [149500]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|1.56||||1.56|1.23|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|<Self-pay>|<Self-pay>|1.56||||1.56|0.47|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1.56||||1.56|0.44|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1.56||||1.56|1.28|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|1.56||||1.56|0.83|1.33|0.41
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|UMR [2035]|UMR CORE [203505]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|CHAMPVA [1240]|CHAMP VA [124000]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1.56||||1.56|||
101341|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR FLARED TIP CURVED SMOOTH LUMEN STANDARD CONNECTOR ADULT LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1.56||||1.56|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|33.75||||33.75|9.55|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|33.75||||33.75|17.82|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|33.75||||33.75|11.71|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|33.75||||33.75|26.66|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHNET [1495]|HEALTHNET [149500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MULTIPLAN [1680]|IHC HS [168011]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|33.75||||33.75|17.96|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.75||||33.75|26.66|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|33.75||||33.75|19.24|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|<Self-pay>|<Self-pay>|33.75||||33.75|10.12|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|AETNA [1015]|AETNA ACO WILCO [101532]|33.75||||33.75|11.71|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.75||||33.75|8.93|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|FMH BENEFIT SERVICES [1390]|FMH [139000]|33.75||||33.75|26.66|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|33.75||||33.75|11.71|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|33.75||||33.75|15.19|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|33.75||||33.75|26.66|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|FIRST HEALTH [1375]|BENVEO/UCS [137512]|33.75||||33.75|17.96|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|TRUSTMARK [2030]|STARMARK [203000]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|WEB TPA [2115]|WEB TPA [211500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|GILSBAR [1425]|GILSBAR [142500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MEDICA [2910]|MEDICA QUEST [291001]|33.75||||33.75|17.96|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|33.75||||33.75|28.69|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|33.75||||33.75|26.66|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHFIRST [2395]|HEALTHFIRST [239500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.75||||33.75|16.2|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|CORESOURCE [1315]|CORESOURCE [131501]|33.75||||33.75|11.71|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|CIGNA [1260]|CIGNA [126008]|33.75||||33.75|17.82|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|33.75||||33.75|15.19|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|33.75||||33.75|18.56|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|33.75||||33.75|27.68|28.69|8.93
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|GEHA [1415]|GEHA - ASA [141503]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BCBS [1155]|TULSA BLUE [115531]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|UMR [2035]|UMR CORE [203505]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|CHAMPVA [1240]|CHAMP VA [124000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|33.75||||33.75|||
10138|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE EPIDURAL PERIFIX TUOHY BPA L3 1/2 IN OD18 GA WING PVC FREE DEHP FREE STERILE LATEX FREE CLEAR|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|33.75||||33.75|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|208.00||||208.00|164.32|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|FMH BENEFIT SERVICES [1390]|FMH [139000]|208.00||||208.00|164.32|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|208.00||||208.00|176.8|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CORESOURCE [1315]|CORESOURCE [131501]|208.00||||208.00|72.18|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GILSBAR [1425]|GILSBAR [142500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|TRUSTMARK [2030]|STARMARK [203000]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|208.00||||208.00|72.18|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MULTIPLAN [1680]|IHC HS [168011]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|208.00||||208.00|164.32|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AETNA [1015]|AETNA ACO WILCO [101532]|208.00||||208.00|72.18|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|208.00||||208.00|93.6|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|WEB TPA [2115]|WEB TPA [211500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|208.00||||208.00|114.4|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|208.00||||208.00|99.84|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|208.00||||208.00|118.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|208.00||||208.00|109.82|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|208.00||||208.00|110.66|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|208.00||||208.00|72.18|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CIGNA [1260]|CIGNA [126008]|208.00||||208.00|109.82|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|208.00||||208.00|164.32|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHNET [1495]|HEALTHNET [149500]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|208.00||||208.00|164.32|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MEDICA [2910]|MEDICA QUEST [291001]|208.00||||208.00|110.66|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|208.00||||208.00|55.06|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|<Self-pay>|<Self-pay>|208.00||||208.00|62.4|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|208.00||||208.00|58.86|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|208.00||||208.00|93.6|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|FIRST HEALTH [1375]|BENVEO/UCS [137512]|208.00||||208.00|110.66|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|208.00||||208.00|170.56|176.8|55.06
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UMR [2035]|UMR CORE [203505]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|TULSA BLUE [115531]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GEHA [1415]|GEHA - ASA [141503]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|CHAMPVA [1240]|CHAMP VA [124000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|208.00||||208.00|||
101430|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SET TUBING STERILE GOFLO PUMP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|208.00||||208.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|170.00||||170.00|93.5|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|170.00||||170.00|76.5|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|170.00||||170.00|45|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|170.00||||170.00|134.3|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MULTIPLAN [1680]|IHC HS [168011]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|170.00||||170.00|90.44|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|170.00||||170.00|134.3|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|170.00||||170.00|134.3|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|<Self-pay>|<Self-pay>|170.00||||170.00|51|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|WEB TPA [2115]|WEB TPA [211500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MEDICA [2910]|MEDICA QUEST [291001]|170.00||||170.00|90.44|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|170.00||||170.00|81.6|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|170.00||||170.00|134.3|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|170.00||||170.00|93.5|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|TRUSTMARK [2030]|STARMARK [203000]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|GILSBAR [1425]|GILSBAR [142500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|170.00||||170.00|144.5|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|FIRST HEALTH [1375]|BENVEO/UCS [137512]|170.00||||170.00|90.44|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|170.00||||170.00|76.5|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|170.00||||170.00|48.11|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|170.00||||170.00|134.3|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHNET [1495]|HEALTHNET [149500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|170.00||||170.00|139.4|144.5|45
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|UMR [2035]|UMR CORE [203505]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|CIGNA [1260]|CIGNA [126008]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|170.00||||170.00|||
101482|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|WASHER ORTHOPEDIC VARIAX NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|170.00||||170.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|COMMUNITY CARE [1290]|COMMUNITY CARE MEDICARE SUPPLEMENT [129003]|2223.00||||2223.00|1756.17|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|CIGNA [1260]|CIGNA [126008]|2223.00||||2223.00|933.66|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2223.00||||2223.00|1067.04|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|CORESOURCE [1315]|CORESOURCE [131501]|2223.00||||2223.00|852.08|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|GILSBAR [1425]|GILSBAR [142500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|TRUSTMARK [2030]|STARMARK [203000]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2223.00||||2223.00|852.08|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MULTIPLAN [1680]|IHC HS [168011]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|2223.00||||2223.00|1182.64|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2223.00||||2223.00|1756.17|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2223.00||||2223.00|588.43|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|AETNA [1015]|AETNA ACO WILCO [101532]|2223.00||||2223.00|852.08|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|<Self-pay>|<Self-pay>|2223.00||||2223.00|666.9|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2223.00||||2223.00|852.08|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|2223.00||||2223.00|1756.17|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|WEB TPA [2115]|WEB TPA [211500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2223.00||||2223.00|1222.65|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|2223.00||||2223.00|1222.65|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2223.00||||2223.00|1000.35|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2223.00||||2223.00|933.66|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHSMART [1505]|HEALTHSMART BENEFIT SOLUTIONS [150503]|2223.00||||2223.00|1889.55|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MEDICA [2910]|MEDICA QUEST [291001]|2223.00||||2223.00|1182.64|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|FMH BENEFIT SERVICES [1390]|FMH [139000]|2223.00||||2223.00|1756.17|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHNET [1495]|HEALTHNET [149500]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|2223.00||||2223.00|1756.17|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2223.00||||2223.00|629.11|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2223.00||||2223.00|1182.64|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2223.00||||2223.00|1000.35|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|2223.00||||2223.00|1822.86|1889.55|588.43
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|UMR [2035]|UMR CORE [203505]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BCBS [1155]|TULSA BLUE [115531]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|OKLAHOMA PROJECT WOMAN [2145]|OKLAHOMA PROJECT WOMAN [214500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|GEHA [1415]|GEHA - ASA [141503]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|CHAMPVA [1240]|CHAMP VA [124000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|HOSPICE [3000]|SOLSTICE HEALTHCARE [300004]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2223.00||||2223.00|||
101649|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL EXETER V40 COCR +0 MM OFFSET TAPER OD36 MM STERILE LFIT|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2223.00||||2223.00|||
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|FIRST HEALTH [1375]|BENVEO/UCS [137512]|2774.50||||2774.50|1476.03|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|PHCS [1780]|LIFESTYLE HEALTH PLANS [178013]|2774.50||||2774.50|2191.86|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2774.50||||2774.50|1464.94|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2774.50||||2774.50|785.18|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2774.50||||2774.50|1525.98|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|2774.50||||2774.50|1581.47|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|<Self-pay>|<Self-pay>|2774.50||||2774.50|832.35|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|2774.50||||2774.50|962.75|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|2774.50||||2774.50|2191.86|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|FMH BENEFIT SERVICES [1390]|FMH [139000]|2774.50||||2774.50|2191.86|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|MULTIPLAN [1680]|IHC HS [168011]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|MULTIPLAN [1680]|PROVIDENCE HEALTH PLAN [168004]|2774.50||||2774.50|1476.03|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2774.50||||2774.50|962.75|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2774.50||||2774.50|1248.53|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2774.50||||2774.50|734.41|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2774.50||||2774.50|962.75|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2774.50||||2774.50|1248.53|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|HEALTHNET [1495]|HEALTHNET [149500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|GROUP RESOURCES [1455]|GROUP RESOURCES [145004]|2774.50||||2774.50|2191.86|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|WEB TPA [2115]|WEB TPA [211500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2774.50||||2774.50|2275.09|2358.33|734.41
101659|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE ARTHROSCOPIC ENDOBLADE GASTROC RECESSION SYSTEM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2774.50||||2774.50|2275.09|2358.33|73