"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"
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|9619.96||||9619.96|2020.19|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|9619.96||||9619.96|2020.19|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|9619.96||||9619.96|1981.71|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|9619.96||||9619.96|5771.97|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|9619.96||||9619.96|7936.46|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9619.96||||9619.96|1981.71|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|9619.96||||9619.96|5897.03|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9619.96||||9619.96|1981.71|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA - ASA [141503]|9619.96||||9619.96|8657.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA [101529]|9619.96||||9619.96|8465.56|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|9619.96||||9619.96|2020.19|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9619.96||||9619.96|9042.76|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|9619.96||||9619.96|8657.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|9619.96||||9619.96|8657.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|9619.96||||9619.96|8657.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|9619.96||||9619.96|8465.56|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|9619.96||||9619.96|7214.97|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA PPO [126025]|9619.96||||9619.96|9042.76|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|9619.96||||9619.96|7695.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|9619.96||||9619.96|8465.56|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|9619.96||||9619.96|1000|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|9619.96||||9619.96|6445.37|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|9619.96||||9619.96|5771.97|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|9619.96||||9619.96|5771.98|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|INSURANCE TPA [168007]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9619.96||||9619.96|8657.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|WEB TPA [2115]|WEB TPA [211500]|9619.96||||9619.96|9138.96|9138.96|1000
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|9619.96||||9619.96|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|9619.96||||9619.96|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|9431.15||||9431.15|7780.7|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9431.15||||9431.15|8865.28|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|9431.15||||9431.15|1942.82|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|9431.15||||9431.15|6318.87|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|STARMARK [203000]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|9431.15||||9431.15|1000|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|9431.15||||9431.15|8299.41|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|INSURANCE TPA [168007]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|9431.15||||9431.15|1980.54|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|9431.15||||9431.15|7544.92|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|9431.15||||9431.15|5658.69|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHNET [1495]|HEALTHNET [149500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|9431.15||||9431.15|7073.36|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA PPO [126025]|9431.15||||9431.15|8865.28|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9431.15||||9431.15|1942.82|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|9431.15||||9431.15|5781.29|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9431.15||||9431.15|1942.82|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|9431.15||||9431.15|1980.54|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GEHA [1415]|GEHA - ASA [141503]|9431.15||||9431.15|8488.04|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9431.15||||9431.15|8488.04|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|WEB TPA [2115]|WEB TPA [211500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|9431.15||||9431.15|1980.54|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|<Self-pay>|<Self-pay>|9431.15||||9431.15|5658.69|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|9431.15||||9431.15|5658.69|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|PHCS MULTIPLAN [178000]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA [101529]|9431.15||||9431.15|8299.41|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|9431.15||||9431.15|8488.04|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|9431.15||||9431.15|8299.41|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9431.15||||9431.15|8959.59|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|9431.15||||9431.15|8488.04|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|9431.15||||9431.15|8488.04|8959.59|1000
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CHAMPVA [1240]|CHAMP VA [124000]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9431.15||||9431.15|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|9431.15||||9431.15|1980.54|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|9431.15||||9431.15|7780.7|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|INSURANCE TPA [168007]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|9431.15||||9431.15|5658.69|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA PPO [126025]|9431.15||||9431.15|8865.28|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA - ASA [141503]|9431.15||||9431.15|8488.04|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|9431.15||||9431.15|6318.87|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9431.15||||9431.15|8488.04|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|9431.15||||9431.15|8299.41|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|9431.15||||9431.15|8488.04|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|9431.15||||9431.15|5781.29|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|PHCS MULTIPLAN [178000]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA [101529]|9431.15||||9431.15|8299.41|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|9431.15||||9431.15|7544.92|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|9431.15||||9431.15|7073.36|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|9431.15||||9431.15|8488.04|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|9431.15||||9431.15|8299.41|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9431.15||||9431.15|1942.82|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|9431.15||||9431.15|5658.69|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|9431.15||||9431.15|1980.54|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|9431.15||||9431.15|1980.54|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|9431.15||||9431.15|8488.04|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9431.15||||9431.15|1942.82|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|9431.15||||9431.15|1942.82|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9431.15||||9431.15|8865.28|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|9431.15||||9431.15|1000|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9431.15||||9431.15|8959.59|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|9431.15||||9431.15|5658.69|8959.59|1000
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9431.15||||9431.15|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|9431.15||||9431.15|1980.54|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|9431.15||||9431.15|7780.7|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA - ASA [141503]|9431.15||||9431.15|8488.04|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|9431.15||||9431.15|1942.82|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|9431.15||||9431.15|8488.04|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|9431.15||||9431.15|5658.69|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9431.15||||9431.15|1942.82|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9431.15||||9431.15|8488.04|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|9431.15||||9431.15|8299.41|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|9431.15||||9431.15|8299.41|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|9431.15||||9431.15|1980.54|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|9431.15||||9431.15|5781.29|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA [101529]|9431.15||||9431.15|8299.41|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|9431.15||||9431.15|7073.36|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA PPO [126025]|9431.15||||9431.15|8865.28|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|PHCS MULTIPLAN [178000]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|9431.15||||9431.15|8488.04|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|INSURANCE TPA [168007]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|9431.15||||9431.15|5658.69|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|9431.15||||9431.15|5658.69|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|9431.15||||9431.15|6318.87|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|9431.15||||9431.15|8488.04|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|9431.15||||9431.15|1000|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|9431.15||||9431.15|7544.92|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|9431.15||||9431.15|1980.54|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9431.15||||9431.15|8865.28|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9431.15||||9431.15|1942.82|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9431.15||||9431.15|8959.59|8959.59|1000
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|9431.15||||9431.15|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|9431.15||||9431.15|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
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 OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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>|1736.59||||1736.59|1041.95|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|1736.59||||1736.59|1632.4|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
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 [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
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]|1736.59||||1736.59|357.74|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|1736.59||||1736.59|1562.93|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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 PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
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 OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
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 UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
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]|1736.59||||1736.59|357.74|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|1736.59||||1736.59|1562.93|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
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 [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
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 [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
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]|1736.59||||1736.59|1649.76|1649.76|11.21
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]|1736.59||||1736.59|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
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]|1736.59||||1736.59|||
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]|1736.59||||1736.59|||
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 ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
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]|1736.59||||1736.59|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
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 HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
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 OUT OF STATE [115512]|1736.59||||1736.59|||
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]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L50 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L55 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INSURANCE TPA [168007]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1736.59||||1736.59|357.74|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1736.59||||1736.59|1432.69|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1736.59||||1736.59|364.68|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|<Self-pay>|<Self-pay>|1736.59||||1736.59|1041.95|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1736.59||||1736.59|1632.4|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHNET [1495]|HEALTHNET [149500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1736.59||||1736.59|1302.44|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1736.59||||1736.59|1064.53|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AETNA [101529]|1736.59||||1736.59|1528.2|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GEHA [1415]|GEHA - ASA [141503]|1736.59||||1736.59|1562.93|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA PPO [126025]|1736.59||||1736.59|1632.4|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1736.59||||1736.59|364.68|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1736.59||||1736.59|1528.2|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1736.59||||1736.59|357.74|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1736.59||||1736.59|1389.27|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1736.59||||1736.59|1528.2|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1736.59||||1736.59|1562.93|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1736.59||||1736.59|1562.93|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1736.59||||1736.59|357.74|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1736.59||||1736.59|11.21|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WEB TPA [2115]|WEB TPA [211500]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1736.59||||1736.59|1562.93|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1736.59||||1736.59|364.68|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1736.59||||1736.59|1041.96|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1736.59||||1736.59|1649.76|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1736.59||||1736.59|1163.52|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1736.59||||1736.59|396|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1736.59||||1736.59|1041.96|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1736.59||||1736.59|13.5|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1736.59||||1736.59|1562.93|1649.76|11.21
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|1736.59||||1736.59|||
100047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L60 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1736.59||||1736.59|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|WEB TPA [2115]|WEB TPA [211500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HEALTHFIRST [2395]|HEALTHFIRST [239500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|12178.30||||12178.30|10716.9|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|GEHA [1415]|GEHA - ASA [141503]|12178.30||||12178.30|10960.47|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|SELECTHEALTH [3740]|SELECTHEALTH [374000]|12178.30||||12178.30|10960.47|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|AETNA [1015]|AETNA [101529]|12178.30||||12178.30|10716.9|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|12178.30||||12178.30|7465.3|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|CIGNA [1260]|CIGNA PPO [126025]|12178.30||||12178.30|11447.6|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|12178.30||||12178.30|9133.72|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|PHCS [1780]|PHCS MULTIPLAN [178000]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|12178.30||||12178.30|11447.6|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12178.30||||12178.30|2508.73|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|12178.30||||12178.30|2557.44|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|12178.30||||12178.30|10960.47|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12178.30||||12178.30|10960.47|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|12178.30||||12178.30|2557.44|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|12178.30||||12178.30|9742.64|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UMR [2035]|UMR UNITED HEALTHCARE [203502]|12178.30||||12178.30|10960.47|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|12178.30||||12178.30|2508.73|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12178.30||||12178.30|2508.73|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|12178.30||||12178.30|10047.1|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|TRUSTMARK [2030]|STARMARK [203000]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|12178.30||||12178.30|7306.98|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|12178.30||||12178.30|2557.44|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|12178.30||||12178.30|8159.46|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|12178.30||||12178.30|1000|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HEALTHNET [1495]|HEALTHNET [149500]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|<Self-pay>|<Self-pay>|12178.30||||12178.30|7306.98|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MAILHANDLERS [1595]|MAILHANDLERS [159500]|12178.30||||12178.30|10716.9|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|12178.30||||12178.30|7306.98|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MULTIPLAN [1680]|INSURANCE TPA [168007]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|12178.30||||12178.30|11569.38|11569.38|1000
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|CHAMPVA [1240]|CHAMP VA [124000]|12178.30||||12178.30|||
100051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE FEMORAL POROUS UNIVERSAL L34 MM KNEE STERILE LATEX FREE SIGMA LCS S-ROM LPS|BCBS [1155]|BCBS CONNECTEDCARE [115549]|12178.30||||12178.30|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|TRUSTMARK [2030]|STARMARK [203000]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MULTIPLAN [1680]|INSURANCE TPA [168007]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1651.98||||1651.98|1486.78|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1651.98||||1651.98|991.19|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|1651.98||||1651.98|677.31|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|1651.98||||1651.98|346.91|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1651.98||||1651.98|1453.74|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|<Self-pay>|<Self-pay>|1651.98||||1651.98|991.19|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|1651.98||||1651.98|346.91|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|1651.98||||1651.98|1552.86|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PHCS [1780]|PHCS MULTIPLAN [178000]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|1651.98||||1651.98|346.91|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1651.98||||1651.98|340.31|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|1651.98||||1651.98|1238.98|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1651.98||||1651.98|1486.78|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|1651.98||||1651.98|1238.98|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1651.98||||1651.98|340.31|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|1651.98||||1651.98|1362.88|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|1651.98||||1651.98|991.19|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|BCBS CONNECTEDCARE [115549]|1651.98||||1651.98|562.17|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|1651.98||||1651.98|1453.74|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|1651.98||||1651.98|1106.82|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|SELECTHEALTH [3740]|SELECTHEALTH [374000]|1651.98||||1651.98|1486.78|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHNET [1495]|HEALTHNET [149500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AETNA [1015]|AETNA [101529]|1651.98||||1651.98|1453.74|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1651.98||||1651.98|340.31|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|1651.98||||1651.98|1321.58|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|WEB TPA [2115]|WEB TPA [211500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CIGNA [1260]|CIGNA PPO [126025]|1651.98||||1651.98|1552.86|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|1651.98||||1651.98|1486.78|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GEHA [1415]|GEHA - ASA [141503]|1651.98||||1651.98|1486.78|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|1651.98||||1651.98|1238.98|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1651.98||||1651.98|1569.38|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|1651.98||||1651.98|1238.98|1569.38|340.31
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CHAMPVA [1240]|CHAMP VA [124000]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1651.98||||1651.98|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|1651.98||||1651.98|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|7167.84||||7167.84|5734.27|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|7167.84||||7167.84|6451.06|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST [2395]|HEALTHFIRST [239500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7167.84||||7167.84|6451.06|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SELECTHEALTH [3740]|SELECTHEALTH [374000]|7167.84||||7167.84|6451.06|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7167.84||||7167.84|1476.58|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|7167.84||||7167.84|6451.06|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA [101529]|7167.84||||7167.84|6307.7|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|7167.84||||7167.84|4393.89|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|7167.84||||7167.84|5375.88|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|7167.84||||7167.84|1505.25|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|7167.84||||7167.84|4802.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PPO [126025]|7167.84||||7167.84|6737.77|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7167.84||||7167.84|6307.7|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7167.84||||7167.84|1476.58|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7167.84||||7167.84|6307.7|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7167.84||||7167.84|6451.06|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|7167.84||||7167.84|1505.25|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INSURANCE TPA [168007]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|7167.84||||7167.84|4300.7|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7167.84||||7167.84|4300.7|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7167.84||||7167.84|6737.77|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7167.84||||7167.84|1476.58|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|7167.84||||7167.84|5913.47|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7167.84||||7167.84|1505.25|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|7167.84||||7167.84|1000|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|7167.84||||7167.84|4300.7|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|7167.84||||7167.84|6809.45|6809.45|1000
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BCBS CONNECTEDCARE [115549]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|7167.84||||7167.84|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|7167.84||||7167.84|4802.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|7167.84||||7167.84|5913.47|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7167.84||||7167.84|4300.7|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7167.84||||7167.84|1476.58|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|7167.84||||7167.84|1000|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7167.84||||7167.84|1476.58|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7167.84||||7167.84|6451.06|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7167.84||||7167.84|6307.7|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7167.84||||7167.84|6737.77|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|7167.84||||7167.84|1505.25|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7167.84||||7167.84|1505.25|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|7167.84||||7167.84|4300.7|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|7167.84||||7167.84|5375.88|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PPO [126025]|7167.84||||7167.84|6737.77|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|7167.84||||7167.84|4393.89|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA [101529]|7167.84||||7167.84|6307.7|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST [2395]|HEALTHFIRST [239500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|7167.84||||7167.84|6451.06|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|7167.84||||7167.84|4300.7|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7167.84||||7167.84|1476.58|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7167.84||||7167.84|6307.7|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SELECTHEALTH [3740]|SELECTHEALTH [374000]|7167.84||||7167.84|6451.06|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INSURANCE TPA [168007]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|7167.84||||7167.84|1505.25|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7167.84||||7167.84|6451.06|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|7167.84||||7167.84|6451.06|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|7167.84||||7167.84|6809.45|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|7167.84||||7167.84|5734.27|6809.45|1000
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BCBS CONNECTEDCARE [115549]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|7167.84||||7167.84|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|7167.84||||7167.84|5734.27|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7167.84||||7167.84|6451.06|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SELECTHEALTH [3740]|SELECTHEALTH [374000]|7167.84||||7167.84|6451.06|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7167.84||||7167.84|6307.7|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|7167.84||||7167.84|6451.06|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|7167.84||||7167.84|6451.06|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST [2395]|HEALTHFIRST [239500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|7167.84||||7167.84|4393.89|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PPO [126025]|7167.84||||7167.84|6737.77|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|7167.84||||7167.84|5375.88|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|7167.84||||7167.84|1505.25|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|7167.84||||7167.84|4802.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA [101529]|7167.84||||7167.84|6307.7|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7167.84||||7167.84|1505.25|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7167.84||||7167.84|1476.58|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|7167.84||||7167.84|1000|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|7167.84||||7167.84|4300.7|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7167.84||||7167.84|1476.58|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|7167.84||||7167.84|4300.7|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7167.84||||7167.84|6451.06|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7167.84||||7167.84|1476.58|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|7167.84||||7167.84|5913.47|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7167.84||||7167.84|4300.7|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7167.84||||7167.84|6737.77|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INSURANCE TPA [168007]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|7167.84||||7167.84|1505.25|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|7167.84||||7167.84|6809.45|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7167.84||||7167.84|6307.7|6809.45|1000
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BCBS CONNECTEDCARE [115549]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7167.84||||7167.84|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7167.84||||7167.84|4300.7|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7167.84||||7167.84|6451.06|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7167.84||||7167.84|1476.58|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7167.84||||7167.84|1505.25|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7167.84||||7167.84|6307.7|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7167.84||||7167.84|6737.77|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|7167.84||||7167.84|1505.25|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|7167.84||||7167.84|1505.25|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PPO [126025]|7167.84||||7167.84|6737.77|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|7167.84||||7167.84|4393.89|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|7167.84||||7167.84|6451.06|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|7167.84||||7167.84|5913.47|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|7167.84||||7167.84|4300.7|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7167.84||||7167.84|1476.58|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7167.84||||7167.84|1476.58|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7167.84||||7167.84|6307.7|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|SELECTHEALTH [3740]|SELECTHEALTH [374000]|7167.84||||7167.84|6451.06|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|7167.84||||7167.84|4300.7|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA [101529]|7167.84||||7167.84|6307.7|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|7167.84||||7167.84|5375.88|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7167.84||||7167.84|6451.06|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|7167.84||||7167.84|6451.06|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|7167.84||||7167.84|1000|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST [2395]|HEALTHFIRST [239500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INSURANCE TPA [168007]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|7167.84||||7167.84|5734.27|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|7167.84||||7167.84|4802.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|7167.84||||7167.84|6809.45|6809.45|1000
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BCBS CONNECTEDCARE [115549]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7167.84||||7167.84|||
100081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7167.84||||7167.84|6451.06|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|SELECTHEALTH [3740]|SELECTHEALTH [374000]|7167.84||||7167.84|6451.06|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7167.84||||7167.84|1476.58|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|7167.84||||7167.84|6451.06|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST [2395]|HEALTHFIRST [239500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|7167.84||||7167.84|4393.89|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|7167.84||||7167.84|5734.27|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|7167.84||||7167.84|5375.88|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|7167.84||||7167.84|1505.25|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|7167.84||||7167.84|4802.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|7167.84||||7167.84|6451.06|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PPO [126025]|7167.84||||7167.84|6737.77|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA [101529]|7167.84||||7167.84|6307.7|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7167.84||||7167.84|1505.25|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7167.84||||7167.84|6307.7|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|7167.84||||7167.84|1000|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|7167.84||||7167.84|4300.7|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7167.84||||7167.84|1476.58|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|7167.84||||7167.84|4300.7|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7167.84||||7167.84|6451.06|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7167.84||||7167.84|1476.58|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7167.84||||7167.84|6307.7|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|7167.84||||7167.84|5913.47|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7167.84||||7167.84|4300.7|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7167.84||||7167.84|6737.77|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INSURANCE TPA [168007]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|7167.84||||7167.84|1505.25|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|7167.84||||7167.84|6809.45|6809.45|1000
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BCBS CONNECTEDCARE [115549]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7167.84||||7167.84|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7167.84||||7167.84|4300.7|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|7167.84||||7167.84|5913.47|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7167.84||||7167.84|1476.58|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7167.84||||7167.84|1476.58|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7167.84||||7167.84|1505.25|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7167.84||||7167.84|6307.7|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7167.84||||7167.84|6737.77|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|7167.84||||7167.84|1505.25|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PPO [126025]|7167.84||||7167.84|6737.77|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|7167.84||||7167.84|4393.89|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA [101529]|7167.84||||7167.84|6307.7|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST [2395]|HEALTHFIRST [239500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|7167.84||||7167.84|6451.06|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|7167.84||||7167.84|1505.25|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|7167.84||||7167.84|4300.7|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7167.84||||7167.84|6451.06|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|7167.84||||7167.84|1000|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7167.84||||7167.84|1476.58|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|7167.84||||7167.84|4300.7|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7167.84||||7167.84|6307.7|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|SELECTHEALTH [3740]|SELECTHEALTH [374000]|7167.84||||7167.84|6451.06|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|7167.84||||7167.84|5375.88|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7167.84||||7167.84|6451.06|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|7167.84||||7167.84|6451.06|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INSURANCE TPA [168007]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|7167.84||||7167.84|5734.27|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|7167.84||||7167.84|4802.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|7167.84||||7167.84|6809.45|6809.45|1000
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BCBS CONNECTEDCARE [115549]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|7167.84||||7167.84|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|7167.84||||7167.84|5734.27|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7167.84||||7167.84|6451.06|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|SELECTHEALTH [3740]|SELECTHEALTH [374000]|7167.84||||7167.84|6451.06|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7167.84||||7167.84|1476.58|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|7167.84||||7167.84|6451.06|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA - ASA [141503]|7167.84||||7167.84|6451.06|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST [2395]|HEALTHFIRST [239500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|7167.84||||7167.84|4393.89|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PPO [126025]|7167.84||||7167.84|6737.77|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|7167.84||||7167.84|5375.88|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|7167.84||||7167.84|1505.25|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|7167.84||||7167.84|4802.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7167.84||||7167.84|6307.7|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA [101529]|7167.84||||7167.84|6307.7|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|7167.84||||7167.84|6307.7|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|7167.84||||7167.84|1505.25|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|7167.84||||7167.84|1000|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|7167.84||||7167.84|4300.7|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR UNITED HEALTHCARE [203502]|7167.84||||7167.84|6451.06|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|7167.84||||7167.84|4300.7|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7167.84||||7167.84|1476.58|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7167.84||||7167.84|1476.58|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|7167.84||||7167.84|5913.47|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7167.84||||7167.84|4300.7|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|7167.84||||7167.84|6737.77|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INSURANCE TPA [168007]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|7167.84||||7167.84|1505.25|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|7167.84||||7167.84|6809.45|6809.45|1000
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BCBS CONNECTEDCARE [115549]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7167.84||||7167.84|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|7167.84||||7167.84|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|31.25||||31.25|6.56|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|INSURANCE TPA [168007]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRUSTMARK [2030]|STARMARK [203000]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|31.25||||31.25|20.94|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UMR UNITED HEALTHCARE [203502]|31.25||||31.25|28.13|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|31.25||||31.25|23.44|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|31.25||||31.25|12.81|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|31.25||||31.25|18.75|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|31.25||||31.25|18.75|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|31.25||||31.25|6.56|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|31.25||||31.25|29.38|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|31.25||||31.25|18.75|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PHCS [1780]|PHCS MULTIPLAN [178000]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|31.25||||31.25|27.5|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|31.25||||31.25|23.44|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PPO [126025]|31.25||||31.25|29.38|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHNET [1495]|HEALTHNET [149500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|31.25||||31.25|23.44|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHFIRST [2395]|HEALTHFIRST [239500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|31.25||||31.25|25.78|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS CONNECTEDCARE [115549]|31.25||||31.25|10.63|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|31.25||||31.25|23.44|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|31.25||||31.25|6.44|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|31.25||||31.25|6.44|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA - ASA [141503]|31.25||||31.25|28.13|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|31.25||||31.25|27.5|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SELECTHEALTH [3740]|SELECTHEALTH [374000]|31.25||||31.25|28.13|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|31.25||||31.25|28.13|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|31.25||||31.25|6.56|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|31.25||||31.25|28.13|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA [101529]|31.25||||31.25|27.5|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|31.25||||31.25|6.44|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WEB TPA [2115]|WEB TPA [211500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|31.25||||31.25|25|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|31.25||||31.25|29.69|29.69|6.44
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|31.25||||31.25|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|31.25||||31.25|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|WEB TPA [2115]|WEB TPA [211500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|49.99||||49.99|44.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|49.99||||49.99|44.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|SELECTHEALTH [3740]|SELECTHEALTH [374000]|49.99||||49.99|44.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|49.99||||49.99|43.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|49.99||||49.99|37.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|GEHA [1415]|GEHA - ASA [141503]|49.99||||49.99|44.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHFIRST [2395]|HEALTHFIRST [239500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AETNA [1015]|AETNA [101529]|49.99||||49.99|43.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|49.99||||49.99|39.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|49.99||||49.99|37.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|49.99||||49.99|37.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|49.99||||49.99|33.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|49.99||||49.99|10.5|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PHCS [1780]|PHCS MULTIPLAN [178000]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CIGNA [1260]|CIGNA PPO [126025]|49.99||||49.99|46.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|<Self-pay>|<Self-pay>|49.99||||49.99|30|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHNET [1495]|HEALTHNET [149500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|49.99||||49.99|37.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BCBS CONNECTEDCARE [115549]|49.99||||49.99|17.01|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|49.99||||49.99|10.3|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|49.99||||49.99|29.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|49.99||||49.99|10.3|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|49.99||||49.99|10.5|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UMR [2035]|UMR UNITED HEALTHCARE [203502]|49.99||||49.99|44.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.99||||49.99|10.3|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MAILHANDLERS [1595]|MAILHANDLERS [159500]|49.99||||49.99|43.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|49.99||||49.99|41.24|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|49.99||||49.99|29.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|49.99||||49.99|46.99|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|49.99||||49.99|20.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MULTIPLAN [1680]|INSURANCE TPA [168007]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|TRUSTMARK [2030]|STARMARK [203000]|49.99||||49.99|47.49|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|49.99||||49.99|10.5|47.49|10.3
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CHAMPVA [1240]|CHAMP VA [124000]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.99||||49.99|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|49.99||||49.99|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INSURANCE TPA [168007]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INSURANCE TPA [168007]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INSURANCE TPA [168007]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|33.25||||33.25|27.43|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|33.25||||33.25|27.43|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|33.25||||33.25|27.43|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|33.25||||33.25|22.28|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|33.25||||33.25|22.28|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|33.25||||33.25|22.28|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|33.25||||33.25|27.43|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|33.25||||33.25|22.28|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|33.25||||33.25|13.63|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|33.25||||33.25|13.63|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|33.25||||33.25|13.63|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|33.25||||33.25|11.31|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|33.25||||33.25|13.63|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|33.25||||33.25|11.31|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.25||||33.25|31.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA [101529]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA [101529]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA [101529]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA [101529]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|33.25||||33.25|11.31|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|33.25||||33.25|11.31|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|33.25||||33.25|24.94|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|33.25||||33.25|6.98|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INSURANCE TPA [168007]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|33.25||||33.25|19.95|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|33.25||||33.25|26.6|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|33.25||||33.25|26.6|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|33.25||||33.25|26.6|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.25||||33.25|29.93|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|33.25||||33.25|26.6|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|33.25||||33.25|6.85|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|33.25||||33.25|31.59|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|33.25||||33.25|29.26|31.59|6.85
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|33.25||||33.25|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.25||||33.25|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|WEB TPA [2115]|WEB TPA [211500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|5972.33||||5972.33|5375.1|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5972.33||||5972.33|5375.1|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|5972.33||||5972.33|5375.1|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5972.33||||5972.33|1230.3|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|5972.33||||5972.33|5255.65|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA - ASA [141503]|5972.33||||5972.33|5375.1|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|5972.33||||5972.33|3661.04|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA [101529]|5972.33||||5972.33|5255.65|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA PPO [126025]|5972.33||||5972.33|5613.99|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|5972.33||||5972.33|4479.25|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|5972.33||||5972.33|1254.19|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|5972.33||||5972.33|4001.46|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|5972.33||||5972.33|3583.4|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5972.33||||5972.33|1230.3|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|5972.33||||5972.33|1000|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|5972.33||||5972.33|3583.4|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|5972.33||||5972.33|1230.3|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|5972.33||||5972.33|1254.19|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|5972.33||||5972.33|5375.1|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|5972.33||||5972.33|5255.65|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|5972.33||||5972.33|4927.17|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|5972.33||||5972.33|5613.99|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|5972.33||||5972.33|4777.86|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|5972.33||||5972.33|3583.4|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|INSURANCE TPA [168007]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|5972.33||||5972.33|5673.71|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|5972.33||||5972.33|1254.19|5673.71|1000
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5972.33||||5972.33|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|5972.33||||5972.33|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|33.25||||33.25|6.98|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|33.25||||33.25|6.85|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|33.25||||33.25|19.95|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MULTIPLAN [1680]|INSURANCE TPA [168007]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|33.25||||33.25|22.28|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|33.25||||33.25|29.93|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|33.25||||33.25|19.95|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|33.25||||33.25|13.63|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|33.25||||33.25|6.85|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|33.25||||33.25|24.94|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|<Self-pay>|<Self-pay>|33.25||||33.25|19.95|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|33.25||||33.25|6.98|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|33.25||||33.25|27.43|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|33.25||||33.25|31.26|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|33.25||||33.25|29.26|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|33.25||||33.25|6.98|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|33.25||||33.25|31.26|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|33.25||||33.25|11.31|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|33.25||||33.25|24.94|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|33.25||||33.25|29.26|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|33.25||||33.25|24.94|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|33.25||||33.25|6.85|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|33.25||||33.25|29.93|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|33.25||||33.25|29.93|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|AETNA [1015]|AETNA [101529]|33.25||||33.25|29.26|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|33.25||||33.25|29.93|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|33.25||||33.25|29.93|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|33.25||||33.25|24.94|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|33.25||||33.25|26.6|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|33.25||||33.25|31.59|31.59|6.85
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|33.25||||33.25|||
10012|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|33.25||||33.25|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|WEB TPA [2115]|WEB TPA [211500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|76.63||||76.63|68.97|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|76.63||||76.63|68.97|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|76.63||||76.63|68.97|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|76.63||||76.63|15.79|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.63||||76.63|67.44|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|76.63||||76.63|57.47|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|76.63||||76.63|68.97|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA [101529]|76.63||||76.63|67.44|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|76.63||||76.63|61.31|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA PPO [126025]|76.63||||76.63|72.04|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|76.63||||76.63|57.47|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|76.63||||76.63|16.09|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PHCS [1780]|PHCS MULTIPLAN [178000]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|76.63||||76.63|72.04|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|76.63||||76.63|51.34|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|76.63||||76.63|57.47|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|<Self-pay>|<Self-pay>|76.63||||76.63|45.98|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|76.63||||76.63|57.47|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|76.63||||76.63|26.08|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|76.63||||76.63|31.42|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|76.63||||76.63|45.98|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|76.63||||76.63|15.79|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.63||||76.63|68.97|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|76.63||||76.63|16.09|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.63||||76.63|67.44|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|76.63||||76.63|63.22|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|76.63||||76.63|45.98|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHNET [1495]|HEALTHNET [149500]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|INSURANCE TPA [168007]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76.63||||76.63|15.79|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|TRUSTMARK [2030]|STARMARK [203000]|76.63||||76.63|72.8|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|76.63||||76.63|16.09|72.8|15.79
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.63||||76.63|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|76.63||||76.63|16.09|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|76.63||||76.63|15.79|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|76.63||||76.63|45.98|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR [2035]|UMR UNITED HEALTHCARE [203502]|76.63||||76.63|68.97|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|76.63||||76.63|15.79|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|76.63||||76.63|45.98|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|76.63||||76.63|31.42|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BCBS CONNECTEDCARE [115549]|76.63||||76.63|26.08|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHNET [1495]|HEALTHNET [149500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|<Self-pay>|<Self-pay>|76.63||||76.63|45.98|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MULTIPLAN [1680]|INSURANCE TPA [168007]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.63||||76.63|67.44|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|TRUSTMARK [2030]|STARMARK [203000]|76.63||||76.63|72.8|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|76.63||||76.63|72.8|72.8|15.79
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]|76.63||||76.63|72.04|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PHCS [1780]|PHCS MULTIPLAN [178000]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|76.63||||76.63|16.09|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|76.63||||76.63|63.22|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CIGNA [1260]|CIGNA PPO [126025]|76.63||||76.63|72.04|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|76.63||||76.63|16.09|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|76.63||||76.63|57.47|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA [1015]|AETNA [101529]|76.63||||76.63|67.44|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GEHA [1415]|GEHA - ASA [141503]|76.63||||76.63|68.97|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|76.63||||76.63|67.44|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|76.63||||76.63|15.79|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|SELECTHEALTH [3740]|SELECTHEALTH [374000]|76.63||||76.63|68.97|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|76.63||||76.63|57.47|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHFIRST [2395]|HEALTHFIRST [239500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|76.63||||76.63|57.47|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|76.63||||76.63|68.97|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|76.63||||76.63|68.97|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|WEB TPA [2115]|WEB TPA [211500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|76.63||||76.63|57.47|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|76.63||||76.63|61.31|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|76.63||||76.63|51.34|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|76.63||||76.63|72.8|72.8|15.79
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CHAMPVA [1240]|CHAMP VA [124000]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|76.63||||76.63|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|76.63||||76.63|||
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]|76.63||||76.63|||
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]|76.63||||76.63|||
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|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|76.63||||76.63|72.8|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|76.63||||76.63|61.31|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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 OPTIONS PPO [206028]|76.63||||76.63|68.97|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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]|76.63||||76.63|68.97|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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|SELECTHEALTH [3740]|SELECTHEALTH [374000]|76.63||||76.63|68.97|72.8|15.79
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 [368500]|76.63||||76.63|67.44|72.8|15.79
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]|76.63||||76.63|15.79|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|76.63||||76.63|57.47|72.8|15.79
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]|76.63||||76.63|68.97|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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 PPO [126025]|76.63||||76.63|72.04|72.8|15.79
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|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|76.63||||76.63|57.47|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|76.63||||76.63|16.09|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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 [101529]|76.63||||76.63|67.44|72.8|15.79
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|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|76.63||||76.63|57.47|72.8|15.79
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]|PHCS MULTIPLAN [178000]|76.63||||76.63|72.8|72.8|15.79
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>|76.63||||76.63|45.98|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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 OF IDAHO [115551]|76.63||||76.63|31.42|72.8|15.79
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 OUT OF STATE [115512]|76.63||||76.63|57.47|72.8|15.79
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|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|76.63||||76.63|72.8|72.8|15.79
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]|BCBS CONNECTEDCARE [115549]|76.63||||76.63|26.08|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|76.63||||76.63|45.98|72.8|15.79
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]|UNITED MEDICAL RESOURCES [203503]|76.63||||76.63|15.79|72.8|15.79
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 UNITED HEALTHCARE [203502]|76.63||||76.63|68.97|72.8|15.79
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 CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|76.63||||76.63|16.09|72.8|15.79
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|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|76.63||||76.63|51.34|72.8|15.79
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|MAILHANDLERS [1595]|MAILHANDLERS [159500]|76.63||||76.63|67.44|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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]|MERITAIN HEALTH FIRST HEALTH [137516]|76.63||||76.63|72.8|72.8|15.79
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 [137514]|76.63||||76.63|63.22|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|76.63||||76.63|45.98|72.8|15.79
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]|INSURANCE TPA [168007]|76.63||||76.63|72.8|72.8|15.79
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]|76.63||||76.63|15.79|72.8|15.79
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]|76.63||||76.63|72.8|72.8|15.79
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]|CORIZON [134003]|76.63||||76.63|16.09|72.8|15.79
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]|76.63||||76.63|72.04|72.8|15.79
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]|76.63||||76.63|||
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 ADVANTAGE PLAN [152500]|76.63||||76.63|||
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|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|76.63||||76.63|||
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 HMO ADVANTAGE [102001]|76.63||||76.63|||
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]|76.63||||76.63|||
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]|76.63||||76.63|||
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|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|76.63||||76.63|||
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|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|76.63||||76.63|||
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|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|76.63||||76.63|||
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]|76.63||||76.63|||
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]|76.63||||76.63|||
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|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|76.63||||76.63|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|132.82||||132.82|106.26|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|168.13||||168.13|134.5|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|132.82||||132.82|27.89|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|168.13||||168.13|35.31|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|168.13||||168.13|34.63|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|168.13||||168.13|100.88|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|132.82||||132.82|79.69|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|INSURANCE TPA [168007]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|168.13||||168.13|138.71|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|132.82||||132.82|109.58|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|168.13||||168.13|112.65|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|132.82||||132.82|88.99|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|132.82||||132.82|79.69|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|168.13||||168.13|100.88|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR UNITED HEALTHCARE [203502]|168.13||||168.13|151.32|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|168.13||||168.13|34.63|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR UNITED HEALTHCARE [203502]|132.82||||132.82|119.54|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS CONNECTEDCARE [115549]|168.13||||168.13|57.21|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS CONNECTEDCARE [115549]|132.82||||132.82|45.2|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|132.82||||132.82|54.46|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|168.13||||168.13|126.1|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|168.13||||168.13|68.93|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|132.82||||132.82|79.69|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|168.13||||168.13|100.88|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|168.13||||168.13|35.31|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAILHANDLERS [1595]|MAILHANDLERS [159500]|168.13||||168.13|147.95|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAILHANDLERS [1595]|MAILHANDLERS [159500]|132.82||||132.82|116.88|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|168.13||||168.13|158.04|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|132.82||||132.82|124.85|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|PHCS MULTIPLAN [178000]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|132.82||||132.82|27.89|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|PHCS MULTIPLAN [178000]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|132.82||||132.82|27.89|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|168.13||||168.13|35.31|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|168.13||||168.13|126.1|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|132.82||||132.82|99.62|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|168.13||||168.13|126.1|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|132.82||||132.82|99.62|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|132.82||||132.82|99.62|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA PPO [126025]|132.82||||132.82|124.85|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA PPO [126025]|168.13||||168.13|158.04|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHFIRST [2395]|HEALTHFIRST [239500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHFIRST [2395]|HEALTHFIRST [239500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA [101529]|168.13||||168.13|147.95|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|132.82||||132.82|27.36|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA [101529]|132.82||||132.82|116.88|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|132.82||||132.82|119.54|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|168.13||||168.13|151.32|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|132.82||||132.82|99.62|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|168.13||||168.13|126.1|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|168.13||||168.13|147.95|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|168.13||||168.13|34.63|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|132.82||||132.82|27.36|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|132.82||||132.82|116.88|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SELECTHEALTH [3740]|SELECTHEALTH [374000]|168.13||||168.13|151.32|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SELECTHEALTH [3740]|SELECTHEALTH [374000]|132.82||||132.82|119.54|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|INSURANCE TPA [168007]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|132.82||||132.82|27.36|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|132.82||||132.82|119.54|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|168.13||||168.13|151.32|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|132.82||||132.82|119.54|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|168.13||||168.13|151.32|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WEB TPA [2115]|WEB TPA [211500]|132.82||||132.82|126.18|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WEB TPA [2115]|WEB TPA [211500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|168.13||||168.13|159.72|159.72|27.36
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|132.82||||132.82|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|168.13||||168.13|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|132.82||||132.82|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4349.10||||4349.10|3479.28|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4349.10||||4349.10|3914.19|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4349.10||||4349.10|3914.19|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4349.10||||4349.10|3827.21|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4349.10||||4349.10|895.91|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4349.10||||4349.10|3914.19|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AETNA [1015]|AETNA [101529]|4349.10||||4349.10|3827.21|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4349.10||||4349.10|4088.15|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4349.10||||4349.10|3261.83|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4349.10||||4349.10|913.31|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4349.10||||4349.10|4088.15|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4349.10||||4349.10|2666|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4349.10||||4349.10|3827.21|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|<Self-pay>|<Self-pay>|4349.10||||4349.10|2609.46|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4349.10||||4349.10|913.31|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4349.10||||4349.10|895.91|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4349.10||||4349.10|3914.19|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4349.10||||4349.10|1000|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4349.10||||4349.10|2609.46|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4349.10||||4349.10|2913.9|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4349.10||||4349.10|895.91|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4349.10||||4349.10|3914.19|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4349.10||||4349.10|3588.01|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4349.10||||4349.10|2609.46|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4349.10||||4349.10|4131.65|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4349.10||||4349.10|913.31|4131.65|895.91
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4349.10||||4349.10|||
100159|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 COCR +0 MM TAPER OD22.2 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4349.10||||4349.10|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|683.96||||683.96|547.17|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|683.96||||683.96|615.57|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|683.96||||683.96|615.57|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|683.96||||683.96|615.57|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|683.96||||683.96|601.89|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|683.96||||683.96|140.9|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|683.96||||683.96|615.57|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|683.96||||683.96|419.27|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|683.96||||683.96|642.92|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|683.96||||683.96|512.97|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|683.96||||683.96|143.63|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|683.96||||683.96|642.92|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|683.96||||683.96|601.89|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|683.96||||683.96|410.37|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA [101529]|683.96||||683.96|601.89|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|683.96||||683.96|143.63|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|683.96||||683.96|11.21|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|683.96||||683.96|13.5|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|683.96||||683.96|396|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|683.96||||683.96|410.38|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|683.96||||683.96|615.57|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|683.96||||683.96|140.9|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|683.96||||683.96|458.25|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|683.96||||683.96|564.27|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|683.96||||683.96|410.38|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|683.96||||683.96|140.9|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|683.96||||683.96|649.76|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|683.96||||683.96|143.63|649.76|11.21
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|683.96||||683.96|||
10017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|683.96||||683.96|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3811.51|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
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]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|683.96||||683.96|140.9|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|683.96||||683.96|564.27|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|683.96||||683.96|615.57|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|683.96||||683.96|140.9|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|683.96||||683.96|410.38|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|683.96||||683.96|396|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|683.96||||683.96|11.21|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|683.96||||683.96|143.63|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|683.96||||683.96|410.37|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|683.96||||683.96|601.89|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|683.96||||683.96|642.92|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|683.96||||683.96|143.63|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|683.96||||683.96|13.5|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|683.96||||683.96|512.97|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|683.96||||683.96|642.92|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA [101529]|683.96||||683.96|601.89|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|683.96||||683.96|419.27|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|683.96||||683.96|458.25|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|683.96||||683.96|615.57|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|683.96||||683.96|601.89|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|683.96||||683.96|140.9|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|683.96||||683.96|615.57|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|683.96||||683.96|410.38|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|683.96||||683.96|143.63|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|683.96||||683.96|615.57|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|683.96||||683.96|615.57|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|683.96||||683.96|547.17|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|683.96||||683.96|649.76|649.76|11.21
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|683.96||||683.96|||
10018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L14 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|683.96||||683.96|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
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 [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
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]|4054.80||||4054.80|3811.51|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
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 [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
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 HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100185|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD47 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
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 ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100188|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD48 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|683.96||||683.96|547.17|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|683.96||||683.96|615.57|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|683.96||||683.96|615.57|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|683.96||||683.96|615.57|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|683.96||||683.96|601.89|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|683.96||||683.96|615.57|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|683.96||||683.96|419.27|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|683.96||||683.96|642.92|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|683.96||||683.96|512.97|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|683.96||||683.96|143.63|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA [101529]|683.96||||683.96|601.89|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|683.96||||683.96|642.92|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|683.96||||683.96|601.89|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|683.96||||683.96|410.37|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|683.96||||683.96|140.9|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|683.96||||683.96|143.63|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|683.96||||683.96|13.5|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|683.96||||683.96|11.21|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|683.96||||683.96|396|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|683.96||||683.96|410.38|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|683.96||||683.96|615.57|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|683.96||||683.96|140.9|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|683.96||||683.96|458.25|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|683.96||||683.96|564.27|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|683.96||||683.96|410.38|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|683.96||||683.96|140.9|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|683.96||||683.96|649.76|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|683.96||||683.96|143.63|649.76|11.21
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|683.96||||683.96|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|683.96||||683.96|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100196|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|683.96||||683.96|615.57|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|683.96||||683.96|615.57|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|683.96||||683.96|615.57|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|683.96||||683.96|140.9|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|683.96||||683.96|601.89|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|683.96||||683.96|419.27|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|683.96||||683.96|642.92|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|683.96||||683.96|512.97|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|683.96||||683.96|143.63|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|683.96||||683.96|642.92|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA [101529]|683.96||||683.96|601.89|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|683.96||||683.96|601.89|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|683.96||||683.96|410.37|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|683.96||||683.96|615.57|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|683.96||||683.96|143.63|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|683.96||||683.96|11.21|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|683.96||||683.96|13.5|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|683.96||||683.96|396|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|683.96||||683.96|410.38|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|683.96||||683.96|140.9|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|683.96||||683.96|615.57|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|683.96||||683.96|547.17|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|683.96||||683.96|458.25|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|683.96||||683.96|564.27|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|683.96||||683.96|410.38|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|683.96||||683.96|140.9|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|683.96||||683.96|649.76|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|683.96||||683.96|143.63|649.76|11.21
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|683.96||||683.96|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|683.96||||683.96|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
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 [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3811.51|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
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]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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 [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
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 HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100200|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD51 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
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 ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100204|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD52 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|683.96||||683.96|547.17|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|683.96||||683.96|615.57|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|683.96||||683.96|615.57|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|683.96||||683.96|615.57|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|683.96||||683.96|601.89|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|683.96||||683.96|615.57|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|683.96||||683.96|419.27|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|683.96||||683.96|642.92|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|683.96||||683.96|512.97|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|683.96||||683.96|143.63|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA [101529]|683.96||||683.96|601.89|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|683.96||||683.96|642.92|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|683.96||||683.96|601.89|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|683.96||||683.96|410.37|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|683.96||||683.96|140.9|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|683.96||||683.96|143.63|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|683.96||||683.96|11.21|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|683.96||||683.96|13.5|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|683.96||||683.96|396|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|683.96||||683.96|410.38|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|683.96||||683.96|615.57|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|683.96||||683.96|140.9|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|683.96||||683.96|458.25|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|683.96||||683.96|564.27|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|683.96||||683.96|410.38|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|683.96||||683.96|140.9|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|683.96||||683.96|649.76|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|683.96||||683.96|143.63|649.76|11.21
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|683.96||||683.96|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|683.96||||683.96|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100211|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
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]|4054.80||||4054.80|3811.51|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
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]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
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]|4054.80||||4054.80|835.29|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
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]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
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]|4054.80||||4054.80|||
100212|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 54MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100216|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD55 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100219|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|683.96||||683.96|458.25|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BCBS [1155]|BCBS CONNECTEDCARE [115549]|683.96||||683.96|11.21|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|683.96||||683.96|410.38|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|683.96||||683.96|140.9|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|683.96||||683.96|601.89|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MULTIPLAN [1680]|INSURANCE TPA [168007]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HEALTHFIRST [2395]|HEALTHFIRST [239500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UMR [2035]|UMR UNITED HEALTHCARE [203502]|683.96||||683.96|615.57|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PHCS [1780]|PHCS MULTIPLAN [178000]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|683.96||||683.96|143.63|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|683.96||||683.96|615.57|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|AETNA [1015]|AETNA [101529]|683.96||||683.96|601.89|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HEALTHNET [1495]|HEALTHNET [149500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|GEHA [1415]|GEHA - ASA [141503]|683.96||||683.96|615.57|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|683.96||||683.96|396|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|<Self-pay>|<Self-pay>|683.96||||683.96|410.37|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|683.96||||683.96|512.97|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|683.96||||683.96|140.9|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|683.96||||683.96|143.63|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|683.96||||683.96|547.17|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|683.96||||683.96|143.63|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|683.96||||683.96|615.57|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|683.96||||683.96|140.9|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|683.96||||683.96|410.38|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MAILHANDLERS [1595]|MAILHANDLERS [159500]|683.96||||683.96|601.89|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|683.96||||683.96|13.5|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|SELECTHEALTH [3740]|SELECTHEALTH [374000]|683.96||||683.96|615.57|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|683.96||||683.96|419.27|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|683.96||||683.96|642.92|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|WEB TPA [2115]|WEB TPA [211500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|683.96||||683.96|642.92|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|TRUSTMARK [2030]|STARMARK [203000]|683.96||||683.96|649.76|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|683.96||||683.96|564.27|649.76|11.21
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|683.96||||683.96|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|683.96||||683.96|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100220|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 56MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100223|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 58MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|4054.80||||4054.80|851.51|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|CIGNA [1260]|CIGNA PPO [126025]|4054.80||||4054.80|3811.51|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|SELECTHEALTH [3740]|SELECTHEALTH [374000]|4054.80||||4054.80|3649.32|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|4054.80||||4054.80|3568.22|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|4054.80||||4054.80|2716.72|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4054.80||||4054.80|835.29|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|PHCS [1780]|PHCS MULTIPLAN [178000]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|4054.80||||4054.80|3649.32|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|WEB TPA [2115]|WEB TPA [211500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|AETNA [1015]|AETNA [101529]|4054.80||||4054.80|3568.22|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4054.80||||4054.80|3649.32|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|4054.80||||4054.80|3811.51|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|4054.80||||4054.80|3041.1|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|4054.80||||4054.80|2485.59|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|4054.80||||4054.80|851.51|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|4054.80||||4054.80|3649.32|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|4054.80||||4054.80|3243.84|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|4054.80||||4054.80|2432.88|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4054.80||||4054.80|2432.88|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4054.80||||4054.80|3649.32|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4054.80||||4054.80|835.29|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|<Self-pay>|<Self-pay>|4054.80||||4054.80|2432.88|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MULTIPLAN [1680]|INSURANCE TPA [168007]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4054.80||||4054.80|835.29|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|4054.80||||4054.80|851.51|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|4054.80||||4054.80|1000|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4054.80||||4054.80|3568.22|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4054.80||||4054.80|3852.06|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|4054.80||||4054.80|3345.21|3852.06|835.29
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|CHAMPVA [1240]|CHAMP VA [124000]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|BCBS [1155]|BCBS CONNECTEDCARE [115549]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|4054.80||||4054.80|||
100224|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD58 MM ID28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4054.80||||4054.80|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|683.96||||683.96|615.57|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|683.96||||683.96|140.9|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|683.96||||683.96|547.17|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|683.96||||683.96|13.5|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|683.96||||683.96|143.63|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|683.96||||683.96|143.63|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|683.96||||683.96|601.89|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|683.96||||683.96|615.57|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|683.96||||683.96|615.57|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA [101529]|683.96||||683.96|601.89|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|683.96||||683.96|419.27|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|683.96||||683.96|601.89|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|683.96||||683.96|410.37|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|683.96||||683.96|642.92|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|683.96||||683.96|458.25|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|683.96||||683.96|512.97|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|683.96||||683.96|642.92|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|683.96||||683.96|410.38|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|683.96||||683.96|140.9|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|683.96||||683.96|11.21|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|683.96||||683.96|564.27|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|683.96||||683.96|615.57|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|683.96||||683.96|396|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|683.96||||683.96|615.57|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|683.96||||683.96|143.63|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|683.96||||683.96|140.9|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|683.96||||683.96|410.38|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|683.96||||683.96|649.76|649.76|11.21
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|683.96||||683.96|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|683.96||||683.96|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|378.38||||378.38|227.03|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|378.38||||378.38|340.55|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|378.38||||378.38|77.95|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|378.38||||378.38|79.46|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|378.38||||378.38|77.95|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|378.38||||378.38|227.03|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|378.38||||378.38|312.17|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|378.38||||378.38|227.03|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|378.38||||378.38|13.5|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|378.38||||378.38|79.46|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|378.38||||378.38|355.68|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|378.38||||378.38|231.95|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA [101529]|378.38||||378.38|332.98|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|378.38||||378.38|332.98|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|378.38||||378.38|77.95|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|378.38||||378.38|340.55|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|378.38||||378.38|340.55|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|378.38||||378.38|340.55|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|378.38||||378.38|79.46|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|378.38||||378.38|283.79|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|378.38||||378.38|332.98|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|378.38||||378.38|355.68|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|378.38||||378.38|253.52|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|378.38||||378.38|340.55|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|378.38||||378.38|11.21|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|378.38||||378.38|359.47|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|378.38||||378.38|302.71|359.47|11.21
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|378.38||||378.38|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|378.38||||378.38|340.55|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|SELECTHEALTH [3740]|SELECTHEALTH [374000]|378.38||||378.38|340.55|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|WEB TPA [2115]|WEB TPA [211500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|378.38||||378.38|340.55|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|378.38||||378.38|302.71|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|378.38||||378.38|340.55|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|378.38||||378.38|79.46|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|378.38||||378.38|332.98|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PHCS [1780]|PHCS MULTIPLAN [178000]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|378.38||||378.38|355.68|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|378.38||||378.38|283.79|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHNET [1495]|HEALTHNET [149500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA [101529]|378.38||||378.38|332.98|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|378.38||||378.38|340.55|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|378.38||||378.38|231.95|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|378.38||||378.38|253.52|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|378.38||||378.38|77.95|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|TRUSTMARK [2030]|STARMARK [203000]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|378.38||||378.38|77.95|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|378.38||||378.38|355.68|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|378.38||||378.38|79.46|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|378.38||||378.38|312.17|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|378.38||||378.38|227.03|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|378.38||||378.38|79.46|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS CONNECTEDCARE [115549]|378.38||||378.38|11.21|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|378.38||||378.38|77.95|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|378.38||||378.38|332.98|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|378.38||||378.38|227.03|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|INSURANCE TPA [168007]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|378.38||||378.38|227.03|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|378.38||||378.38|13.5|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|378.38||||378.38|359.47|359.47|11.21
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|378.38||||378.38|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|378.38||||378.38|13.5|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|378.38||||378.38|227.03|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|378.38||||378.38|283.79|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|378.38||||378.38|332.98|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|378.38||||378.38|355.68|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|378.38||||378.38|227.03|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|378.38||||378.38|340.55|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA [101529]|378.38||||378.38|332.98|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHNET [1495]|HEALTHNET [149500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|378.38||||378.38|302.71|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|378.38||||378.38|355.68|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PHCS [1780]|PHCS MULTIPLAN [178000]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SELECTHEALTH [3740]|SELECTHEALTH [374000]|378.38||||378.38|340.55|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|378.38||||378.38|332.98|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|378.38||||378.38|77.95|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|378.38||||378.38|340.55|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|378.38||||378.38|77.95|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|378.38||||378.38|77.95|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|378.38||||378.38|79.46|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|378.38||||378.38|231.95|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|378.38||||378.38|253.52|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|378.38||||378.38|340.55|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|WEB TPA [2115]|WEB TPA [211500]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|378.38||||378.38|79.46|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS CONNECTEDCARE [115549]|378.38||||378.38|11.21|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|378.38||||378.38|79.46|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|TRUSTMARK [2030]|STARMARK [203000]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|378.38||||378.38|312.17|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|378.38||||378.38|227.03|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|INSURANCE TPA [168007]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|378.38||||378.38|359.47|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|378.38||||378.38|340.55|359.47|11.21
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|378.38||||378.38|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|378.38||||378.38|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|9431.15||||9431.15|1980.54|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|SELECTHEALTH [3740]|SELECTHEALTH [374000]|9431.15||||9431.15|8488.04|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|9431.15||||9431.15|7544.92|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|9431.15||||9431.15|6318.87|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9431.15||||9431.15|8488.04|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9431.15||||9431.15|1942.82|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|9431.15||||9431.15|5781.29|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9431.15||||9431.15|8865.28|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AETNA [1015]|AETNA [101529]|9431.15||||9431.15|8299.41|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HEALTHNET [1495]|HEALTHNET [149500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|<Self-pay>|<Self-pay>|9431.15||||9431.15|5658.69|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|9431.15||||9431.15|7073.36|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|9431.15||||9431.15|1980.54|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9431.15||||9431.15|1942.82|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MAILHANDLERS [1595]|MAILHANDLERS [159500]|9431.15||||9431.15|8299.41|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|PHCS [1780]|PHCS MULTIPLAN [178000]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|9431.15||||9431.15|8299.41|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|WEB TPA [2115]|WEB TPA [211500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|CIGNA [1260]|CIGNA PPO [126025]|9431.15||||9431.15|8865.28|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|9431.15||||9431.15|8488.04|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|9431.15||||9431.15|1000|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|TRUSTMARK [2030]|STARMARK [203000]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UMR [2035]|UMR UNITED HEALTHCARE [203502]|9431.15||||9431.15|8488.04|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|9431.15||||9431.15|1942.82|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|9431.15||||9431.15|7780.7|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MULTIPLAN [1680]|INSURANCE TPA [168007]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|9431.15||||9431.15|1980.54|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|GEHA [1415]|GEHA - ASA [141503]|9431.15||||9431.15|8488.04|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|9431.15||||9431.15|5658.69|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|9431.15||||9431.15|5658.69|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9431.15||||9431.15|8959.59|8959.59|1000
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HMA HEALTHCARE MANAGE ADMIN [3620]|HMA HEALTHCARE MANAGE ADMIN [362000]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|CHAMPVA [1240]|CHAMP VA [124000]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|BCBS [1155]|BLUE CROSS OF IDAHO [115551]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|BCBS [1155]|BLUE CROSS OUT OF STATE [115512]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|PACIFIC SOURCE MEDICARE REPLACEMENT [3710]|PACIFIC SOURCE MEDICARE [371000]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|BLUE SHIELD OF IDAHO [3535]|BLUE SHIELD OF IDAHO [353500]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|BCBS [1155]|BCBS CONNECTEDCARE [115549]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|BLUE SHIELD MEDICARE REP [3540]|BLUE SHIELD OF IDAHO MEDICARE [354000]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|WELLCARE MEDICARE REPLACEMENT [3775]|WELLCARE MEDICARE [377501]|9431.15||||9431.15|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|9431.15||||9431.15|||
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|TRUSTMARK [2030]|STARMARK [203000]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MULTIPLAN [1680]|INSURANCE TPA [168007]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|9431.15||||9431.15|1942.82|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|GEHA [1415]|GEHA - ASA [141503]|9431.15||||9431.15|8488.04|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137514]|9431.15||||9431.15|7780.7|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|TRANSAMERICAN LIFE [1990]|TRANSAMERICAN LIFE [199000]|9431.15||||9431.15|1000|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|HEALTHNET [1495]|HEALTHNET [149500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|UNITED HEALTHCARE CENTENNIAL CARE [2250]|UHC COMM MCAID HEALTH PLA [225001]|9431.15||||9431.15|1980.54|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|EMPLOYEE BENEFIT MANAGEMENT SERVICES [2445]|EMPLOYEE BENEFIT MANAGEMENT SERVICES [244501]|9431.15||||9431.15|8865.28|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|PHCS [1780]|PHCS MULTIPLAN [178000]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|IDAHO MEDICAID [3665]|IDAHO MEDICAID [366500]|9431.15||||9431.15|1980.54|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|AETNA [1015]|AETNA [101529]|9431.15||||9431.15|8299.41|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|9431.15||||9431.15|5658.69|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|9431.15||||9431.15|1942.82|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|DEPARTMENT OF CORRECTIONS [1340]|CORIZON [134003]|9431.15||||9431.15|1980.54|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|9431.15||||9431.15|1942.82|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|<Self-pay>|<Self-pay>|9431.15||||9431.15|5658.69|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MERITAIN AETNA [3685]|MERITAIN AETNA [368500]|9431.15||||9431.15|8299.41|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|UT ID TEAMSTERS [3760]|UT ID TEAMSTERS [376001]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|DELTA HEALTH SYSTEMS [3855]|DELTA HEALTH SYSTEMS [385501]|9431.15||||9431.15|6318.87|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|SELECTHEALTH [3740]|SELECTHEALTH [374000]|9431.15||||9431.15|8488.04|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MOUNTAIN HEALTH CO OP [3690]|MOUNTAIN HEALTH CO OP [369000]|9431.15||||9431.15|7073.36|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|LIBERTY HEALTH SHARE LHS/MEDCOST SOLUTIONS LLC [24|LIBERTY HEALTHSHARE [240001]|9431.15||||9431.15|5658.69|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|CIGNA [1260]|CIGNA PPO [126025]|9431.15||||9431.15|8865.28|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|PACIFIC SOURCE HEALTH PLANS [2850]|PACIFIC SOURCE HEALTH PLANS [285000]|9431.15||||9431.15|5781.29|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|FIRST HEALTH [1375]|MERITAIN HEALTH FIRST HEALTH [137516]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|UNITED HEALTHCARE [2060]|UHC OPTIONS PPO [206028]|9431.15||||9431.15|8488.04|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|UMR [2035]|UMR UNITED HEALTHCARE [203502]|9431.15||||9431.15|8488.04|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|DESERET HEALTHCARE [3585]|DESERET HEALTHCARE [358500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|MAILHANDLERS [1595]|MAILHANDLERS [159500]|9431.15||||9431.15|8299.41|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|WEB TPA [2115]|WEB TPA [211500]|9431.15||||9431.15|8959.59|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|UNION PACIFIC RAILROAD EMPLOYEES HEALTH SYSTEMS [3|UPREHS MEDICARE SUPPLEMENT [384001]|9431.15||||9431.15|7544.92|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131 MM HIP CEMENT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|9431.15||||9431.15|8488.04|8959.59|1000
100298|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 3 43 MM OFFSET L131