"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|BCBS [1155]|EMPIRE BCBS PPO [115559]|1653.29||||1653.29|1545|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|1653.29||||1653.29|195.82|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS UNION [362506]|1653.29||||1653.29|1545|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|1653.29||||1653.29|909.31|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|1653.29||||1653.29|991.97|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1653.29||||1653.29|195.82|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1653.29||||1653.29|810.11|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|1653.29||||1653.29|892.78|1653.29|150.45
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]|1653.29||||1653.29|537.48|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1653.29||||1653.29|195.82|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA SIGNATURE [101528]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON FEDERAL [362504]|1653.29||||1653.29|1545|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|1653.29||||1653.29|991.97|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|1653.29||||1653.29|1545|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1653.29||||1653.29|975.44|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|1653.29||||1653.29|537.48|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|1653.29||||1653.29|743.98|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|1653.29||||1653.29|892.78|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|1653.29||||1653.29|1545|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|1653.29||||1653.29|975.44|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA INDEMNITY [126019]|1653.29||||1653.29|909.31|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|1653.29||||1653.29|217.57|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1653.29||||1653.29|1405.29|1653.29|150.45
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]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|1653.29||||1653.29|217.57|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|WEB TPA [2115]|WEB TPA [211500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|1653.29||||1653.29|975.44|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|1653.29||||1653.29|1545|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1653.29||||1653.29|909.31|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA - ASA [141503]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|1653.29||||1653.29|1545|1653.29|150.45
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]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MVA [1690]|MVA OTHER-MRA [169000]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|1653.29||||1653.29|1249.89|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|1653.29||||1653.29|195.82|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|1653.29||||1653.29|1322.63|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1653.29||||1653.29|150.45|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|1653.29||||1653.29|1405.29|1653.29|150.45
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]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|1653.29||||1653.29|1074.64|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|1653.29||||1653.29|1653.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|1653.29||||1653.29|975.44|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GILSBAR [1425]|GILSBAR [142500]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|QUALCARE [3725]|QUALCARE PPO [372503]|1653.29||||1653.29|975.44|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|IHC HS [168011]|1653.29||||1653.29|1405.29|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|1653.29||||1653.29|909.31|1653.29|150.45
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|1653.29||||1653.29|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|1653.29||||1653.29|||
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|211.41||||211.41|179.7|211.41|19.24
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]|THE EMPIRE PLAN [206029]|211.41||||211.41|197.56|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|68.73|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON FEDERAL [362504]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|116.28|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|211.41||||211.41|197.56|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|211.41||||211.41|159.83|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVA [1690]|MVA OTHER-MRA [169000]|211.41||||211.41|211.41|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|211.41||||211.41|114.16|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS UNION [362506]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|211.41||||211.41|114.16|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|211.41||||211.41|211.41|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|211.41||||211.41|25.04|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|211.41||||211.41|126.85|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|211.41||||211.41|116.28|211.41|19.24
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 HMO POS OPEN ACCESS [126018]|211.41||||211.41|116.28|211.41|19.24
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 INDEMNITY [126019]|211.41||||211.41|116.28|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|211.41||||211.41|27.82|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|211.41||||211.41|25.04|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|211.41||||211.41|126.85|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|211.41||||211.41|25.04|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.41||||211.41|211.41|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|211.41||||211.41|137.42|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|211.41||||211.41|197.56|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE HMO/POS [372501]|211.41||||211.41|124.73|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.41||||211.41|179.7|211.41|19.24
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 [137508]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|211.41||||211.41|124.73|211.41|19.24
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 COMMERCIAL [214001]|211.41||||211.41|124.73|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|211.41||||211.41|211.41|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS PPO [115559]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|19.24|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|211.41||||211.41|169.13|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
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>|211.41||||211.41|211.41|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|211.41||||211.41|25.04|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|211.41||||211.41|68.73|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|211.41||||211.41|103.59|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|211.41||||211.41|95.14|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|211.41||||211.41|27.82|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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 SIGNATURE [101528]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE PPO [372503]|211.41||||211.41|124.73|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.41||||211.41|124.73|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.41||||211.41|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|211.41||||211.41|||
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]|UNITED HEALTHCARE OXFORD [206009]|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|UNITED HEALTHCARE [206025]|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|211.41||||211.41|||
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]|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|211.41||||211.41|||
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]|211.41||||211.41|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE PPO [372503]|211.41||||211.41|124.73|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|211.41||||211.41|114.16|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE HMO/POS [372501]|211.41||||211.41|124.73|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|211.41||||211.41|25.04|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|211.41||||211.41|116.28|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|THE EMPIRE PLAN [206029]|211.41||||211.41|197.56|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|211.41||||211.41|126.85|211.41|19.24
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 [137508]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|211.41||||211.41|27.82|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|211.41||||211.41|25.04|211.41|19.24
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 HMO POS OPEN ACCESS [126018]|211.41||||211.41|116.28|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|211.41||||211.41|114.16|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|211.41||||211.41|27.82|211.41|19.24
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]|211.41||||211.41|116.28|211.41|19.24
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 INDEMNITY [126019]|211.41||||211.41|116.28|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|211.41||||211.41|25.04|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|211.41||||211.41|95.14|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|211.41||||211.41|159.83|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS PPO [115559]|211.41||||211.41|197.56|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|211.41||||211.41|197.56|211.41|19.24
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 COMMERCIAL [214001]|211.41||||211.41|124.73|211.41|19.24
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>|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS UNION [362506]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|19.24|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON FEDERAL [362504]|211.41||||211.41|197.56|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|211.41||||211.41|126.85|211.41|19.24
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]|211.41||||211.41|68.73|211.41|19.24
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 SIGNATURE [101528]|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|211.41||||211.41|137.42|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVA [1690]|MVA OTHER-MRA [169000]|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|211.41||||211.41|197.56|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|211.41||||211.41|68.73|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|211.41||||211.41|124.73|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.41||||211.41|124.73|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|211.41||||211.41|25.04|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|211.41||||211.41|103.59|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.41||||211.41|211.41|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|211.41||||211.41|169.13|211.41|19.24
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.41||||211.41|||
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]|UNITED HEALTHCARE [206025]|211.41||||211.41|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|211.41||||211.41|||
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]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|211.41||||211.41|||
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]|UNITED HEALTHCARE OXFORD [206009]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|211.41||||211.41|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|211.41||||211.41|159.83|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.41||||211.41|124.73|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|211.41||||211.41|68.73|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|19.24|211.41|19.24
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 SIGNATURE [101528]|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|211.41||||211.41|126.85|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|211.41||||211.41|124.73|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|211.41||||211.41|95.14|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|116.28|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|211.41||||211.41|169.13|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|211.41||||211.41|114.16|211.41|19.24
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 INDEMNITY [126019]|211.41||||211.41|116.28|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|211.41||||211.41|103.59|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS PPO [115559]|211.41||||211.41|197.56|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE HMO/POS [372501]|211.41||||211.41|124.73|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|211.41||||211.41|197.56|211.41|19.24
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 COMMERCIAL [214001]|211.41||||211.41|124.73|211.41|19.24
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>|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON FEDERAL [362504]|211.41||||211.41|197.56|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|211.41||||211.41|27.82|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS UNION [362506]|211.41||||211.41|197.56|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|68.73|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE PPO [372503]|211.41||||211.41|124.73|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVA [1690]|MVA OTHER-MRA [169000]|211.41||||211.41|211.41|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|211.41||||211.41|27.82|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|211.41||||211.41|114.16|211.41|19.24
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 HMO POS OPEN ACCESS [126018]|211.41||||211.41|116.28|211.41|19.24
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]|THE EMPIRE PLAN [206029]|211.41||||211.41|197.56|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|211.41||||211.41|137.42|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|211.41||||211.41|126.85|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|211.41||||211.41|25.04|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|211.41||||211.41|116.28|211.41|19.24
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.41||||211.41|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|211.41||||211.41|||
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]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|211.41||||211.41|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|211.41||||211.41|27.82|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.41||||211.41|211.41|211.41|19.24
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 INDEMNITY [126019]|211.41||||211.41|116.28|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|211.41||||211.41|68.73|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|211.41||||211.41|126.85|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|211.41||||211.41|25.04|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVA [1690]|MVA OTHER-MRA [169000]|211.41||||211.41|211.41|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|211.41||||211.41|159.83|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|211.41||||211.41|137.42|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|211.41||||211.41|114.16|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|211.41||||211.41|25.04|211.41|19.24
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]|THE EMPIRE PLAN [206029]|211.41||||211.41|197.56|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|211.41||||211.41|25.04|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|211.41||||211.41|116.28|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|116.28|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|211.41||||211.41|169.13|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|211.41||||211.41|114.16|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS UNION [362506]|211.41||||211.41|197.56|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|211.41||||211.41|197.56|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON FEDERAL [362504]|211.41||||211.41|197.56|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|211.41||||211.41|95.14|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|211.41||||211.41|25.04|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|211.41||||211.41|126.85|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|211.41||||211.41|27.82|211.41|19.24
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]|211.41||||211.41|68.73|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS PPO [115559]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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 [137508]|211.41||||211.41|179.7|211.41|19.24
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 HMO POS OPEN ACCESS [126018]|211.41||||211.41|116.28|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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>|211.41||||211.41|211.41|211.41|19.24
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 COMMERCIAL [214001]|211.41||||211.41|124.73|211.41|19.24
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]|211.41||||211.41|19.24|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|211.41||||211.41|124.73|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.41||||211.41|124.73|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.41||||211.41|179.7|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|211.41||||211.41|211.41|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|211.41||||211.41|211.41|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE PPO [372503]|211.41||||211.41|124.73|211.41|19.24
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 SIGNATURE [101528]|211.41||||211.41|211.41|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|211.41||||211.41|103.59|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE HMO/POS [372501]|211.41||||211.41|124.73|211.41|19.24
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.41||||211.41|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|211.41||||211.41|||
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]|UNITED HEALTHCARE OXFORD [206009]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.41||||211.41|||
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]|UNITED HEALTHCARE [206025]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|211.41||||211.41|||
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]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|211.41||||211.41|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|211.41||||211.41|||
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]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE HMO/POS [372501]|211.41||||211.41|124.73|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE PPO [372503]|211.41||||211.41|124.73|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|211.41||||211.41|197.56|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|211.41||||211.41|124.73|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|211.41||||211.41|27.82|211.41|19.24
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>|211.41||||211.41|211.41|211.41|19.24
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 COMMERCIAL [214001]|211.41||||211.41|124.73|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS PPO [115559]|211.41||||211.41|197.56|211.41|19.24
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 [137508]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|211.41||||211.41|169.13|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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 INDEMNITY [126019]|211.41||||211.41|116.28|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.41||||211.41|179.7|211.41|19.24
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 SIGNATURE [101528]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|19.24|211.41|19.24
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 HMO POS OPEN ACCESS [126018]|211.41||||211.41|116.28|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|211.41||||211.41|126.85|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|116.28|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|211.41||||211.41|27.82|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|211.41||||211.41|114.16|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|211.41||||211.41|126.85|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|211.41||||211.41|211.41|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVA [1690]|MVA OTHER-MRA [169000]|211.41||||211.41|211.41|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS UNION [362506]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|211.41||||211.41|197.56|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|211.41||||211.41|25.04|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|211.41||||211.41|25.04|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|211.41||||211.41|116.28|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|211.41||||211.41|137.42|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON FEDERAL [362504]|211.41||||211.41|197.56|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|211.41||||211.41|197.56|211.41|19.24
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]|THE EMPIRE PLAN [206029]|211.41||||211.41|197.56|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|211.41||||211.41|211.41|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|211.41||||211.41|25.04|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|211.41||||211.41|95.14|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|211.41||||211.41|114.16|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|211.41||||211.41|68.73|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.41||||211.41|124.73|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|211.41||||211.41|103.59|211.41|19.24
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]|211.41||||211.41|68.73|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|211.41||||211.41|159.83|211.41|19.24
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|211.41||||211.41|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|UNITED HEALTHCARE [206025]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|211.41||||211.41|||
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]|UNITED HEALTHCARE OXFORD [206009]|211.41||||211.41|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.41||||211.41|||
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 [137508]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE HMO/POS [372501]|211.41||||211.41|124.73|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|211.41||||211.41|103.59|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|211.41||||211.41|211.41|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE PPO [372503]|211.41||||211.41|124.73|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|211.41||||211.41|124.73|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|211.41||||211.41|68.73|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.41||||211.41|124.73|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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>|211.41||||211.41|211.41|211.41|19.24
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 COMMERCIAL [214001]|211.41||||211.41|124.73|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|211.41||||211.41|137.42|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|THE EMPIRE PLAN [206029]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|211.41||||211.41|116.28|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|211.41||||211.41|211.41|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|211.41||||211.41|159.83|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|211.41||||211.41|126.85|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|211.41||||211.41|114.16|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVA [1690]|MVA OTHER-MRA [169000]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS UNION [362506]|211.41||||211.41|197.56|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON FEDERAL [362504]|211.41||||211.41|197.56|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|211.41||||211.41|25.04|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|116.28|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|211.41||||211.41|197.56|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|211.41||||211.41|27.82|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|68.73|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|211.41||||211.41|211.41|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|211.41||||211.41|114.16|211.41|19.24
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 INDEMNITY [126019]|211.41||||211.41|116.28|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|211.41||||211.41|211.41|211.41|19.24
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 HMO POS OPEN ACCESS [126018]|211.41||||211.41|116.28|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|19.24|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|211.41||||211.41|95.14|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.41||||211.41|211.41|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|211.41||||211.41|169.13|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|211.41||||211.41|27.82|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|211.41||||211.41|197.56|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS PPO [115559]|211.41||||211.41|197.56|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|211.41||||211.41|126.85|211.41|19.24
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 SIGNATURE [101528]|211.41||||211.41|211.41|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.41||||211.41|179.7|211.41|19.24
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|211.41||||211.41|||
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]|211.41||||211.41|||
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]|UNITED HEALTHCARE [206025]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|211.41||||211.41|||
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]|UNITED HEALTHCARE OXFORD [206009]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|211.41||||211.41|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.41||||211.41|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|211.41||||211.41|68.73|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|211.41||||211.41|103.59|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|211.41||||211.41|179.7|211.41|19.24
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>|211.41||||211.41|211.41|211.41|19.24
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 [137508]|211.41||||211.41|179.7|211.41|19.24
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 SIGNATURE [101528]|211.41||||211.41|211.41|211.41|19.24
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 COMMERCIAL [214001]|211.41||||211.41|124.73|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|211.41||||211.41|211.41|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|EMPIRE BCBS PPO [115559]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|211.41||||211.41|169.13|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|211.41||||211.41|211.41|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|211.41||||211.41|95.14|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|211.41||||211.41|211.41|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE PPO [372503]|211.41||||211.41|124.73|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|211.41||||211.41|124.73|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|IHC HS [168011]|211.41||||211.41|179.7|211.41|19.24
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 HMO POS OPEN ACCESS [126018]|211.41||||211.41|116.28|211.41|19.24
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 INDEMNITY [126019]|211.41||||211.41|116.28|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|QUALCARE [3725]|QUALCARE HMO/POS [372501]|211.41||||211.41|124.73|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|211.41||||211.41|25.04|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|211.41||||211.41|114.16|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|211.41||||211.41|27.82|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|211.41||||211.41|25.04|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|211.41||||211.41|211.41|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|211.41||||211.41|27.82|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|116.28|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|211.41||||211.41|159.83|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVA [1690]|MVA OTHER-MRA [169000]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|19.24|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|211.41||||211.41|25.04|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|211.41||||211.41|126.85|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|211.41||||211.41|116.28|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GILSBAR [1425]|GILSBAR [142500]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|211.41||||211.41|25.04|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|211.41||||211.41|211.41|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|211.41||||211.41|124.73|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS UNION [362506]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|68.73|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
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]|211.41||||211.41|211.41|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|211.41||||211.41|126.85|211.41|19.24
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]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|211.41||||211.41|114.16|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|211.41||||211.41|179.7|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON FEDERAL [362504]|211.41||||211.41|197.56|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|211.41||||211.41|197.56|211.41|19.24
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|211.41||||211.41|137.42|211.41|19.24
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]|THE EMPIRE PLAN [206029]|211.41||||211.41|197.56|211.41|19.24
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]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|211.41||||211.41|||
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]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|211.41||||211.41|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|211.41||||211.41|||
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]|UNITED HEALTHCARE [206025]|211.41||||211.41|||
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]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|211.41||||211.41|||
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]|UNITED HEALTHCARE OXFORD [206009]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|211.41||||211.41|||
100044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L45 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|211.41||||211.41|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|QUALCARE [3725]|QUALCARE PPO [372503]|4823.00||||4823.00|2845.57|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|4823.00||||4823.00|4507.09|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|4823.00||||4823.00|1567.96|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|<Self-pay>|<Self-pay>|4823.00||||4823.00|4823|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON [3625]|HORIZON FEDERAL [362504]|4823.00||||4823.00|4507.09|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|4823.00||||4823.00|4507.09|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|4823.00||||4823.00|3134.95|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|GILSBAR [1425]|GILSBAR [142500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|4823.00||||4823.00|1929.2|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HEALTHFIRST [2395]|HEALTHFIRST [239500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|4823.00||||4823.00|571.24|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|4823.00||||4823.00|1646.47|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|4823.00||||4823.00|2652.65|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|GEHA [1415]|GEHA - ASA [141503]|4823.00||||4823.00|1646.47|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|4823.00||||4823.00|571.24|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|4823.00||||4823.00|4507.09|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|4823.00||||4823.00|2604.42|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MVA [1690]|MVA OTHER-MRA [169000]|4823.00||||4823.00|4823|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|4823.00||||4823.00|2893.8|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|4823.00||||4823.00|3000|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|4823.00||||4823.00|571.24|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|4823.00||||4823.00|3646.19|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4823.00||||4823.00|2652.65|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|4823.00||||4823.00|2893.8|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|4823.00||||4823.00|2604.42|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|4823.00||||4823.00|2652.65|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|CIGNA [1260]|CIGNA INDEMNITY [126019]|4823.00||||4823.00|2652.65|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON [3625]|HORIZON BCBS UNION [362506]|4823.00||||4823.00|4507.09|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4823.00||||4823.00|2845.57|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4823.00||||4823.00|438.89|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|4823.00||||4823.00|4507.09|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|4823.00||||4823.00|3858.4|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4823.00||||4823.00|1646.47|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|WEB TPA [2115]|WEB TPA [211500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|4823.00||||4823.00|634.71|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4823.00||||4823.00|571.24|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|4823.00||||4823.00|4823|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|BCBS [1155]|EMPIRE BCBS PPO [115559]|4823.00||||4823.00|4507.09|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|4823.00||||4823.00|2170.35|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|4823.00||||4823.00|634.71|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4823.00||||4823.00|1567.96|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HEALTHNET [1495]|HEALTHNET [149500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|4823.00||||4823.00|2845.57|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|TRUSTMARK [2030]|STARMARK [203000]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4823.00||||4823.00|2363.27|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|4823.00||||4823.00|2845.57|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MULTIPLAN [1680]|IHC HS [168011]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4823.00||||4823.00|1646.47|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AETNA [1015]|AETNA SIGNATURE [101528]|4823.00||||4823.00|1646.47|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|QUALCARE [3725]|QUALCARE HMO/POS [372501]|4823.00||||4823.00|2845.57|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4823.00||||4823.00|1646.47|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|4823.00||||4823.00|4099.55|4823|438.89
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|4823.00||||4823.00|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UMR [2035]|UMR UNITED HEALTHCARE [203502]|4823.00||||4823.00|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|451.36||||451.36|421.8|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|451.36||||451.36|341.23|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|451.36||||451.36|53.46|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|451.36||||451.36|437.82|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|451.36||||451.36|451.36|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|451.36||||451.36|59.4|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|451.36||||451.36|329.49|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|451.36||||451.36|378.69|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|451.36||||451.36|431.05|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|QUALCARE [3725]|QUALCARE HMO/POS [372501]|451.36||||451.36|431.05|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|QUALCARE [3725]|QUALCARE PPO [372503]|451.36||||451.36|431.05|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|451.36||||451.36|146.74|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|451.36||||451.36|99.3|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|451.36||||451.36|421.8|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MULTIPLAN [1680]|IHC HS [168011]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|451.36||||451.36|329.49|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|TRUSTMARK [2030]|STARMARK [203000]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|<Self-pay>|<Self-pay>|451.36||||451.36|451.36|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|451.36||||451.36|431.05|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|451.36||||451.36|41.07|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AETNA [1015]|AETNA SIGNATURE [101528]|451.36||||451.36|329.49|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|451.36||||451.36|421.8|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|BCBS [1155]|EMPIRE BCBS PPO [115559]|451.36||||451.36|421.8|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|WEB TPA [2115]|WEB TPA [211500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|451.36||||451.36|361.09|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|451.36||||451.36|329.49|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|451.36||||451.36|99.3|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|CIGNA [1260]|CIGNA INDEMNITY [126019]|451.36||||451.36|409.83|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|451.36||||451.36|409.83|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|451.36||||451.36|451.36|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|451.36||||451.36|451.36|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|451.36||||451.36|437.82|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|451.36||||451.36|59.4|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON [3625]|HORIZON FEDERAL [362504]|451.36||||451.36|421.8|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|451.36||||451.36|409.83|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON [3625]|HORIZON BCBS UNION [362506]|451.36||||451.36|421.8|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|451.36||||451.36|400.27|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MVA [1690]|MVA OTHER-MRA [169000]|451.36||||451.36|451.36|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|451.36||||451.36|146.74|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|451.36||||451.36|421.8|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|451.36||||451.36|53.46|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|451.36||||451.36|53.46|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HEALTHFIRST [2395]|HEALTHFIRST [239500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|451.36||||451.36|329.49|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|451.36||||451.36|409.83|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HEALTHNET [1495]|HEALTHNET [149500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|GILSBAR [1425]|GILSBAR [142500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|451.36||||451.36|53.46|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|GEHA [1415]|GEHA - ASA [141503]|451.36||||451.36|329.49|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|451.36||||451.36|383.66|451.36|41.07
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|UMR [2035]|UMR UNITED HEALTHCARE [203502]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|451.36||||451.36|||
100066|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|COUNTERSINK DRILL TUFFNEK HOLE COUNTERBORE 3 IN 1|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|451.36||||451.36|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|GEHA [1415]|GEHA - ASA [141503]|298.48||||298.48|217.89|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|298.48||||298.48|35.35|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|298.48||||298.48|217.89|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHNET [1495]|HEALTHNET [149500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|298.48||||298.48|298.48|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|298.48||||298.48|289.53|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MVA [1690]|MVA OTHER-MRA [169000]|298.48||||298.48|298.48|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|298.48||||298.48|35.35|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|298.48||||298.48|278.93|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AETNA [1015]|AETNA SIGNATURE [101528]|298.48||||298.48|217.89|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|298.48||||298.48|278.93|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|298.48||||298.48|298.48|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|298.48||||298.48|39.28|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|298.48||||298.48|250.42|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|<Self-pay>|<Self-pay>|298.48||||298.48|298.48|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|298.48||||298.48|65.67|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|QUALCARE [3725]|QUALCARE HMO/POS [372501]|298.48||||298.48|285.05|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|298.48||||298.48|217.89|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|QUALCARE [3725]|QUALCARE PPO [372503]|298.48||||298.48|285.05|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|TRUSTMARK [2030]|STARMARK [203000]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|298.48||||298.48|217.89|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MULTIPLAN [1680]|IHC HS [168011]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|298.48||||298.48|271.02|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|298.48||||298.48|285.05|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|298.48||||298.48|97.04|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|298.48||||298.48|225.65|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|298.48||||298.48|27.16|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|298.48||||298.48|278.93|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|WEB TPA [2115]|WEB TPA [211500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|298.48||||298.48|217.89|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS [1155]|EMPIRE BCBS PPO [115559]|298.48||||298.48|278.93|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|298.48||||298.48|238.78|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|298.48||||298.48|285.05|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|298.48||||298.48|65.67|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CIGNA [1260]|CIGNA INDEMNITY [126019]|298.48||||298.48|271.02|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|298.48||||298.48|289.53|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|298.48||||298.48|97.04|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|298.48||||298.48|264.69|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|298.48||||298.48|271.02|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|298.48||||298.48|39.28|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON [3625]|HORIZON BCBS UNION [362506]|298.48||||298.48|278.93|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON [3625]|HORIZON FEDERAL [362504]|298.48||||298.48|278.93|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|298.48||||298.48|298.48|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|298.48||||298.48|278.93|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHFIRST [2395]|HEALTHFIRST [239500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|298.48||||298.48|271.02|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|GILSBAR [1425]|GILSBAR [142500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|298.48||||298.48|35.35|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|298.48||||298.48|35.35|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|298.48||||298.48|253.71|298.48|27.16
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UMR [2035]|UMR UNITED HEALTHCARE [203502]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|298.48||||298.48|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|298.48||||298.48|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|201.11||||201.11|146.81|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|201.11||||201.11|65.38|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|201.11||||201.11|192.06|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|<Self-pay>|<Self-pay>|201.11||||201.11|201.11|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|201.11||||201.11|192.06|201.11|18.3
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]|201.11||||201.11|18.3|201.11|18.3
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]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|201.11||||201.11|182.61|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|201.11||||201.11|201.11|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|201.11||||201.11|160.89|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|201.11||||201.11|146.81|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|201.11||||201.11|195.08|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|201.11||||201.11|201.11|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|201.11||||201.11|195.08|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|201.11||||201.11|201.11|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|201.11||||201.11|26.47|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|201.11||||201.11|23.82|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|201.11||||201.11|187.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON [3625]|HORIZON FEDERAL [362504]|201.11||||201.11|187.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|201.11||||201.11|178.34|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|201.11||||201.11|187.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHFIRST [2395]|HEALTHFIRST [239500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHNET [1495]|HEALTHNET [149500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|201.11||||201.11|170.94|201.11|18.3
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]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GEHA [1415]|GEHA - ASA [141503]|201.11||||201.11|146.81|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|201.11||||201.11|23.82|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GILSBAR [1425]|GILSBAR [142500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|201.11||||201.11|146.81|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|201.11||||201.11|182.61|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|201.11||||201.11|23.82|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|201.11||||201.11|23.82|201.11|18.3
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]|201.11||||201.11|65.38|201.11|18.3
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]|201.11||||201.11|182.61|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|201.11||||201.11|152.04|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MVA [1690]|MVA OTHER-MRA [169000]|201.11||||201.11|201.11|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON [3625]|HORIZON BCBS UNION [362506]|201.11||||201.11|187.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CIGNA [1260]|CIGNA INDEMNITY [126019]|201.11||||201.11|182.61|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|201.11||||201.11|170.94|201.11|18.3
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]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|201.11||||201.11|26.47|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|EMPIRE BCBS PPO [115559]|201.11||||201.11|187.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|WEB TPA [2115]|WEB TPA [211500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|201.11||||201.11|44.24|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|201.11||||201.11|187.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AETNA [1015]|AETNA SIGNATURE [101528]|201.11||||201.11|146.81|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MULTIPLAN [1680]|IHC HS [168011]|201.11||||201.11|170.94|201.11|18.3
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]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|TRUSTMARK [2030]|STARMARK [203000]|201.11||||201.11|170.94|201.11|18.3
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]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|201.11||||201.11|187.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|201.11||||201.11|146.81|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|201.11||||201.11|170.94|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|201.11||||201.11|44.24|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|QUALCARE [3725]|QUALCARE HMO/POS [372501]|201.11||||201.11|192.06|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|QUALCARE [3725]|QUALCARE PPO [372503]|201.11||||201.11|192.06|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|201.11||||201.11|168.73|201.11|18.3
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UMR [2035]|UMR UNITED HEALTHCARE [203502]|201.11||||201.11|||
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]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|201.11||||201.11|||
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]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|201.11||||201.11|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|201.11||||201.11|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|992.63||||992.63|595.58|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|992.63||||992.63|545.95|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AETNA [1015]|AETNA SIGNATURE [101528]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|992.63||||992.63|90.33|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|992.63||||992.63|585.65|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|WEB TPA [2115]|WEB TPA [211500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|992.63||||992.63|130.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|BCBS [1155]|EMPIRE BCBS PPO [115559]|992.63||||992.63|927.61|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|992.63||||992.63|322.7|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|992.63||||992.63|486.39|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|992.63||||992.63|585.65|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|992.63||||992.63|585.65|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|992.63||||992.63|585.65|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|992.63||||992.63|927.61|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MULTIPLAN [1680]|IHC HS [168011]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|QUALCARE [3725]|QUALCARE PPO [372503]|992.63||||992.63|585.65|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|992.63||||992.63|927.61|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|992.63||||992.63|794.1|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|992.63||||992.63|446.68|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|992.63||||992.63|536.02|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|992.63||||992.63|536.02|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|992.63||||992.63|595.58|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|992.63||||992.63|130.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|992.63||||992.63|117.57|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON FEDERAL [362504]|992.63||||992.63|927.61|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA INDEMNITY [126019]|992.63||||992.63|545.95|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|992.63||||992.63|545.95|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|992.63||||992.63|117.57|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|GILSBAR [1425]|GILSBAR [142500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|992.63||||992.63|545.95|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|992.63||||992.63|645.21|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|992.63||||992.63|117.57|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|992.63||||992.63|927.61|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|992.63||||992.63|117.57|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|992.63||||992.63|322.7|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|992.63||||992.63|843.73|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MVA [1690]|MVA OTHER-MRA [169000]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS UNION [362506]|992.63||||992.63|927.61|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|992.63||||992.63|927.61|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|GEHA [1415]|GEHA - ASA [141503]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|992.63||||992.63|992.63|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|992.63||||992.63|750.43|992.63|90.33
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|992.63||||992.63|||
100072|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT BUMPER GMRS NEUTRAL KNEE PROXIMAL MODULAR ROTATE HINGE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|992.63||||992.63|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|997.36||||997.36|997.36|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|QUALCARE [3725]|QUALCARE PPO [372503]|997.36||||997.36|588.44|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|997.36||||997.36|588.44|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|997.36||||997.36|488.71|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|997.36||||997.36|932.03|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|997.36|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|997.36||||997.36|588.44|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|997.36||||997.36|324.24|997.36|90.76
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>|997.36||||997.36|997.36|997.36|90.76
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 [137508]|997.36||||997.36|847.76|997.36|90.76
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 COMMERCIAL [214001]|997.36||||997.36|588.44|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|EMPIRE BCBS PPO [115559]|997.36||||997.36|932.03|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|997.36||||997.36|932.03|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|997.36||||997.36|131.25|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|997.36||||997.36|997.36|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|997.36||||997.36|448.81|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA SIGNATURE [101528]|997.36||||997.36|997.36|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|997.36||||997.36|548.55|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA INDEMNITY [126019]|997.36||||997.36|548.55|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|997.36||||997.36|538.57|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|997.36||||997.36|538.57|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|997.36||||997.36|131.25|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|90.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|997.36||||997.36|797.89|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|997.36||||997.36|997.36|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|997.36||||997.36|932.03|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON FEDERAL [362504]|997.36||||997.36|932.03|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MVA [1690]|MVA OTHER-MRA [169000]|997.36||||997.36|997.36|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|324.24|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|997.36||||997.36|932.03|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|997.36||||997.36|118.13|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|997.36||||997.36|648.28|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|997.36||||997.36|754|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|997.36||||997.36|548.55|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS UNION [362506]|997.36||||997.36|932.03|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|997.36||||997.36|997.36|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|QUALCARE [3725]|QUALCARE HMO/POS [372501]|997.36||||997.36|588.44|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GILSBAR [1425]|GILSBAR [142500]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|997.36||||997.36|118.13|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|997.36||||997.36|997.36|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|997.36||||997.36|118.13|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|997.36||||997.36|598.42|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|997.36||||997.36|598.42|997.36|90.76
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]|997.36||||997.36|548.55|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|997.36||||997.36|118.13|997.36|90.76
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]|997.36||||997.36|997.36|997.36|90.76
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]|997.36||||997.36|||
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]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|997.36||||997.36|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|997.36||||997.36|||
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]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|997.36||||997.36|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|997.36||||997.36|118.13|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|997.36||||997.36|997.36|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|997.36||||997.36|648.28|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|997.36||||997.36|932.03|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|324.24|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|997.36||||997.36|118.13|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|997.36||||997.36|932.03|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|997.36||||997.36|997.36|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GILSBAR [1425]|GILSBAR [142500]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON FEDERAL [362504]|997.36||||997.36|932.03|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|997.36||||997.36|754|997.36|90.76
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]|997.36||||997.36|548.55|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|997.36||||997.36|131.25|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|997.36||||997.36|598.42|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|997.36||||997.36|118.13|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|997.36||||997.36|538.57|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|997.36||||997.36|538.57|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|997.36||||997.36|548.55|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA SIGNATURE [101528]|997.36||||997.36|997.36|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|997.36||||997.36|448.81|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|997.36||||997.36|131.25|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|997.36||||997.36|847.76|997.36|90.76
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 [137508]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|997.36||||997.36|324.24|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|997.36||||997.36|598.42|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|997.36||||997.36|118.13|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|997.36||||997.36|588.44|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|997.36||||997.36|932.03|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON [3625]|HORIZON BCBS UNION [362506]|997.36||||997.36|932.03|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|997.36||||997.36|548.55|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MVA [1690]|MVA OTHER-MRA [169000]|997.36||||997.36|997.36|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|997.36||||997.36|588.44|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|QUALCARE [3725]|QUALCARE PPO [372503]|997.36||||997.36|588.44|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|997.36||||997.36|997.36|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|997.36||||997.36|488.71|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|IHC HS [168011]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|QUALCARE [3725]|QUALCARE HMO/POS [372501]|997.36||||997.36|588.44|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|997.36|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|997.36||||997.36|847.76|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
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>|997.36||||997.36|997.36|997.36|90.76
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 COMMERCIAL [214001]|997.36||||997.36|588.44|997.36|90.76
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]|997.36||||997.36|997.36|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|EMPIRE BCBS PPO [115559]|997.36||||997.36|932.03|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|997.36||||997.36|932.03|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|997.36||||997.36|997.36|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|997.36||||997.36|797.89|997.36|90.76
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]|997.36||||997.36|90.76|997.36|90.76
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]|997.36||||997.36|847.76|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|997.36||||997.36|997.36|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA INDEMNITY [126019]|997.36||||997.36|548.55|997.36|90.76
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|997.36||||997.36|||
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]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|997.36||||997.36|||
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]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|997.36||||997.36|||
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]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|997.36||||997.36|||
100085|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL 0MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|997.36||||997.36|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|997.36||||997.36|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|604.52||||604.52|441.3|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|604.52||||604.52|132.99|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|QUALCARE [3725]|QUALCARE HMO/POS [372501]|604.52||||604.52|577.32|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MULTIPLAN [1680]|IHC HS [168011]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|604.52||||604.52|577.32|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GEHA [1415]|GEHA - ASA [141503]|604.52||||604.52|441.3|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|<Self-pay>|<Self-pay>|604.52||||604.52|604.52|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|604.52||||604.52|577.32|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS [1155]|EMPIRE BCBS PPO [115559]|604.52||||604.52|564.92|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|604.52||||604.52|564.92|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|604.52||||604.52|604.52|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|WEB TPA [2115]|WEB TPA [211500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|604.52||||604.52|483.62|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|604.52||||604.52|441.3|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|604.52||||604.52|55.01|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|604.52||||604.52|132.99|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|604.52||||604.52|548.9|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CIGNA [1260]|CIGNA INDEMNITY [126019]|604.52||||604.52|548.9|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|604.52||||604.52|604.52|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|604.52||||604.52|586.38|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|604.52||||604.52|79.55|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|604.52||||604.52|71.6|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AETNA [1015]|AETNA SIGNATURE [101528]|604.52||||604.52|441.3|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|QUALCARE [3725]|QUALCARE PPO [372503]|604.52||||604.52|577.32|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|604.52||||604.52|507.19|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|604.52||||604.52|548.9|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON [3625]|HORIZON BCBS UNION [362506]|604.52||||604.52|564.92|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|604.52||||604.52|564.92|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|604.52||||604.52|79.55|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|604.52||||604.52|457.02|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|604.52||||604.52|441.3|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|604.52||||604.52|196.53|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|604.52||||604.52|196.53|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|604.52||||604.52|564.92|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|604.52||||604.52|71.6|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHFIRST [2395]|HEALTHFIRST [239500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|604.52||||604.52|564.92|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON [3625]|HORIZON FEDERAL [362504]|604.52||||604.52|564.92|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|604.52||||604.52|548.9|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|604.52||||604.52|536.09|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GILSBAR [1425]|GILSBAR [142500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|604.52||||604.52|441.3|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|604.52||||604.52|71.6|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|604.52||||604.52|586.38|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MVA [1690]|MVA OTHER-MRA [169000]|604.52||||604.52|604.52|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|604.52||||604.52|604.52|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|604.52||||604.52|513.84|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|604.52||||604.52|71.6|604.52|55.01
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UMR [2035]|UMR UNITED HEALTHCARE [203502]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|604.52||||604.52|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|604.52||||604.52|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|0.34||||0.34|0.03|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA SIGNATURE [101528]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|0.34||||0.34|0.27|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA INDEMNITY [126019]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|EMPIRE BCBS PPO [115559]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|0.34||||0.34|0.33|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|0.34||||0.34|0.26|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS UNION [362506]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON FEDERAL [362504]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|0.34||||0.34|0.3|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVA [1690]|MVA OTHER-MRA [169000]|0.34||||0.34|0.34|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|0.34||||0.34|0.11|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|IHC HS [168011]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST [2395]|HEALTHFIRST [239500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|0.34||||0.34|0.31|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|0.34||||0.34|0.07|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE PPO [372503]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|0.34||||0.34|0.25|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|QUALCARE [3725]|QUALCARE HMO/POS [372501]|0.34||||0.34|0.32|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR UNITED HEALTHCARE [203502]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|0.34||||0.34|0.29|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|0.34||||0.34|0.04|0.34|0.03
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|0.34||||0.34|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|831.01||||831.01|490.3|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|QUALCARE [3725]|QUALCARE PPO [372503]|831.01||||831.01|490.3|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|IHC HS [168011]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|831.01||||831.01|776.58|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|831.01||||831.01|490.3|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|831.01||||831.01|270.16|831.01|75.62
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]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|831.01||||831.01|490.3|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|EMPIRE BCBS PPO [115559]|831.01||||831.01|776.58|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|831.01||||831.01|776.58|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|831.01||||831.01|109.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|WEB TPA [2115]|WEB TPA [211500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|831.01||||831.01|664.81|831.01|75.62
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]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|831.01||||831.01|373.96|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|831.01||||831.01|75.62|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA SIGNATURE [101528]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA INDEMNITY [126019]|831.01||||831.01|457.06|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|831.01||||831.01|457.06|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|831.01||||831.01|448.75|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|831.01||||831.01|498.61|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|831.01||||831.01|498.61|831.01|75.62
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]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|831.01||||831.01|448.75|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|831.01||||831.01|109.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|831.01||||831.01|98.43|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS UNION [362506]|831.01||||831.01|776.58|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON FEDERAL [362504]|831.01||||831.01|776.58|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|831.01||||831.01|776.58|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|831.01||||831.01|628.25|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|831.01||||831.01|457.06|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MVA [1690]|MVA OTHER-MRA [169000]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|831.01||||831.01|706.36|831.01|75.62
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]|831.01||||831.01|270.16|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|831.01||||831.01|776.58|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|831.01||||831.01|98.43|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|831.01||||831.01|540.16|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|831.01||||831.01|407.2|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|831.01||||831.01|457.06|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|831.01||||831.01|490.3|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|GILSBAR [1425]|GILSBAR [142500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|831.01||||831.01|98.43|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|831.01||||831.01|706.36|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|831.01||||831.01|98.43|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA - ASA [141503]|831.01||||831.01|831.01|831.01|75.62
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|831.01||||831.01|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|831.01||||831.01|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|87.59||||87.59|10.37|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|130.59||||130.59|15.47|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|87.59||||87.59|10.37|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|130.59||||130.59|15.47|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|130.59||||130.59|95.33|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|87.59||||87.59|63.94|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GILSBAR [1425]|GILSBAR [142500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|87.59||||87.59|79.53|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHFIRST [2395]|HEALTHFIRST [239500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|87.59||||87.59|10.37|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|130.59||||130.59|15.47|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|130.59||||130.59|122.04|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|87.59||||87.59|81.85|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|130.59||||130.59|42.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|87.59||||87.59|28.48|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MVA [1690]|MVA OTHER-MRA [169000]|87.59||||87.59|87.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|87.59||||87.59|66.22|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|87.59||||87.59|81.85|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON FEDERAL [362504]|87.59||||87.59|81.85|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|87.59||||87.59|77.67|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|130.59||||130.59|98.73|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON FEDERAL [362504]|130.59||||130.59|122.04|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|130.59||||130.59|115.81|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|130.59||||130.59|122.04|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|87.59||||87.59|79.53|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|130.59||||130.59|118.58|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|87.59||||87.59|10.37|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|130.59||||130.59|15.47|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|87.59||||87.59|11.53|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|87.59||||87.59|87.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|130.59||||130.59|130.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|130.59||||130.59|126.67|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|130.59||||130.59|126.67|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|87.59||||87.59|87.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|87.59||||87.59|84.96|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|87.59||||87.59|84.96|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|87.59||||87.59|79.53|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA INDEMNITY [126019]|130.59||||130.59|118.58|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA INDEMNITY [126019]|87.59||||87.59|79.53|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|130.59||||130.59|118.58|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|130.59||||130.59|130.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA SIGNATURE [101528]|130.59||||130.59|95.33|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA SIGNATURE [101528]|87.59||||87.59|63.94|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|87.59||||87.59|7.97|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|130.59||||130.59|11.88|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|87.59||||87.59|19.27|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|130.59||||130.59|28.73|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|130.59||||130.59|17.19|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|130.59||||130.59|95.33|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|87.59||||87.59|63.94|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|TRUSTMARK [2030]|STARMARK [203000]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|130.59||||130.59|104.47|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|87.59||||87.59|70.07|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WEB TPA [2115]|WEB TPA [211500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|WEB TPA [2115]|WEB TPA [211500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|130.59||||130.59|17.19|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|87.59||||87.59|11.53|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|130.59||||130.59|130.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|87.59||||87.59|87.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|87.59||||87.59|81.85|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|130.59||||130.59|122.04|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|EMPIRE BCBS PPO [115559]|87.59||||87.59|81.85|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|EMPIRE BCBS PPO [115559]|130.59||||130.59|122.04|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS UNION [362506]|130.59||||130.59|122.04|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON [3625]|HORIZON BCBS UNION [362506]|87.59||||87.59|81.85|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MVA [1690]|MVA OTHER-MRA [169000]|130.59||||130.59|130.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|130.59||||130.59|124.71|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|87.59||||87.59|83.65|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|130.59||||130.59|130.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|87.59||||87.59|87.59|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|130.59||||130.59|42.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHFIRST [2395]|HEALTHFIRST [239500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|87.59||||87.59|28.48|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|87.59||||87.59|63.94|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|130.59||||130.59|95.33|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|130.59||||130.59|118.58|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|130.59||||130.59|124.71|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|87.59||||87.59|83.65|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHNET [1495]|HEALTHNET [149500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|130.59||||130.59|95.33|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|87.59||||87.59|63.94|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GILSBAR [1425]|GILSBAR [142500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|130.59||||130.59|122.04|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|87.59||||87.59|81.85|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|IHC HS [168011]|130.59||||130.59|111|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|87.59||||87.59|74.45|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|87.59||||87.59|19.27|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|130.59||||130.59|28.73|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|QUALCARE [3725]|QUALCARE HMO/POS [372501]|87.59||||87.59|83.65|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|QUALCARE [3725]|QUALCARE PPO [372503]|87.59||||87.59|83.65|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|87.59||||87.59|73.49|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|QUALCARE [3725]|QUALCARE PPO [372503]|130.59||||130.59|124.71|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|QUALCARE [3725]|QUALCARE HMO/POS [372501]|130.59||||130.59|124.71|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|130.59||||130.59|109.57|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|87.59||||87.59|63.94|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|130.59||||130.59|95.33|130.59|7.97
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|130.59||||130.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR UNITED HEALTHCARE [203502]|87.59||||87.59|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR UNITED HEALTHCARE [203502]|130.59||||130.59|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100168|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 41MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|83.27||||83.27|9.86|83.27|7.58
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|83.27||||83.27|83.27|83.27|7.58
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]|GROUP HEALTH COOPERATIVE SCW [178012]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|83.27||||83.27|54.12|83.27|7.58
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|83.27||||83.27|9.86|83.27|7.58
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]|THE EMPIRE PLAN [206029]|83.27||||83.27|77.81|83.27|7.58
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|27.07|83.27|7.58
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|MVA [1690]|MVA OTHER-MRA [169000]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON [3625]|HORIZON FEDERAL [362504]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|83.27||||83.27|62.95|83.27|7.58
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]|83.27||||83.27|45.8|83.27|7.58
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|83.27||||83.27|49.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|83.27||||83.27|49.96|83.27|7.58
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|83.27||||83.27|10.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|83.27||||83.27|44.96|83.27|7.58
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 HMO POS OPEN ACCESS [126018]|83.27||||83.27|45.8|83.27|7.58
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 INDEMNITY [126019]|83.27||||83.27|45.8|83.27|7.58
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 SIGNATURE [101528]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|7.58|83.27|7.58
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|83.27||||83.27|37.47|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.27||||83.27|83.27|83.27|7.58
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|83.27||||83.27|66.61|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|83.27||||83.27|10.96|83.27|7.58
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]|EMPIRE BCBS HMO POS EPO [115558]|83.27||||83.27|77.81|83.27|7.58
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]|EMPIRE BCBS PPO [115559]|83.27||||83.27|77.81|83.27|7.58
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.27||||83.27|70.78|83.27|7.58
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 COMMERCIAL [214001]|83.27||||83.27|49.13|83.27|7.58
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 [137508]|83.27||||83.27|70.78|83.27|7.58
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>|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|GILSBAR [1425]|GILSBAR [142500]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|83.27||||83.27|27.07|83.27|7.58
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.27||||83.27|70.78|83.27|7.58
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|83.27||||83.27|70.78|83.27|7.58
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.27||||83.27|49.13|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.27||||83.27|70.78|83.27|7.58
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|83.27||||83.27|77.81|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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]|IHC HS [168011]|83.27||||83.27|70.78|83.27|7.58
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|83.27||||83.27|40.8|83.27|7.58
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|QUALCARE PPO [372503]|83.27||||83.27|49.13|83.27|7.58
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|83.27||||83.27|||
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|83.27||||83.27|||
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]|83.27||||83.27|||
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]|UNITED HEALTHCARE OXFORD [206009]|83.27||||83.27|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|83.27||||83.27|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.27||||83.27|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|83.27||||83.27|||
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]|UNITED HEALTHCARE [206025]|83.27||||83.27|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.27||||83.27|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|83.27||||83.27|||
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|83.27||||83.27|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|83.27||||83.27|||
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|83.27||||83.27|||
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]|83.27||||83.27|||
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]|83.27||||83.27|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
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]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100176|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 44MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
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]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
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 [137508]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
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]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD45 MM ID28 MM HIP|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
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]|564.20||||564.20|||
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|83.27||||83.27|83.27|83.27|7.58
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|QUALCARE [3725]|QUALCARE PPO [372503]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|83.27||||83.27|49.13|83.27|7.58
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|83.27||||83.27|40.8|83.27|7.58
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]|IHC HS [168011]|83.27||||83.27|70.78|83.27|7.58
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|83.27||||83.27|70.78|83.27|7.58
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|83.27||||83.27|27.07|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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>|83.27||||83.27|83.27|83.27|7.58
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 [137508]|83.27||||83.27|70.78|83.27|7.58
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 COMMERCIAL [214001]|83.27||||83.27|49.13|83.27|7.58
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.27||||83.27|70.78|83.27|7.58
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]|EMPIRE BCBS PPO [115559]|83.27||||83.27|77.81|83.27|7.58
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]|EMPIRE BCBS HMO POS EPO [115558]|83.27||||83.27|77.81|83.27|7.58
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|83.27||||83.27|10.96|83.27|7.58
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|83.27||||83.27|66.61|83.27|7.58
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|83.27||||83.27|37.47|83.27|7.58
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]|83.27||||83.27|7.58|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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 SIGNATURE [101528]|83.27||||83.27|83.27|83.27|7.58
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 HMO POS OPEN ACCESS [126018]|83.27||||83.27|45.8|83.27|7.58
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 INDEMNITY [126019]|83.27||||83.27|45.8|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|83.27||||83.27|49.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|83.27||||83.27|49.96|83.27|7.58
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|83.27||||83.27|10.96|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|45.8|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|83.27||||83.27|62.95|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON FEDERAL [362504]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|83.27||||83.27|83.27|83.27|7.58
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|MVA [1690]|MVA OTHER-MRA [169000]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|27.07|83.27|7.58
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|83.27||||83.27|70.78|83.27|7.58
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.27||||83.27|49.13|83.27|7.58
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|83.27||||83.27|77.81|83.27|7.58
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]|THE EMPIRE PLAN [206029]|83.27||||83.27|77.81|83.27|7.58
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|83.27||||83.27|54.12|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|GROUP HEALTH COOPERATIVE SCW [178012]|83.27||||83.27|70.78|83.27|7.58
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|GILSBAR [1425]|GILSBAR [142500]|83.27||||83.27|70.78|83.27|7.58
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|83.27||||83.27|83.27|83.27|7.58
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|||
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|83.27||||83.27|||
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|83.27||||83.27|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.27||||83.27|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|83.27||||83.27|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.27||||83.27|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|83.27||||83.27|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|83.27||||83.27|||
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]|UNITED HEALTHCARE [206025]|83.27||||83.27|||
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]|UNITED HEALTHCARE OXFORD [206009]|83.27||||83.27|||
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]|83.27||||83.27|||
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]|83.27||||83.27|||
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|83.27||||83.27|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|83.27||||83.27|||
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|83.27||||83.27|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
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]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 28MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
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]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
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]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
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]|83.27||||83.27|83.27|83.27|7.58
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|83.27||||83.27|9.86|83.27|7.58
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|83.27||||83.27|9.86|83.27|7.58
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|83.27||||83.27|83.27|83.27|7.58
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|GILSBAR [1425]|GILSBAR [142500]|83.27||||83.27|70.78|83.27|7.58
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]|GROUP HEALTH COOPERATIVE SCW [178012]|83.27||||83.27|70.78|83.27|7.58
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|83.27||||83.27|54.12|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|83.27||||83.27|9.86|83.27|7.58
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]|THE EMPIRE PLAN [206029]|83.27||||83.27|77.81|83.27|7.58
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|27.07|83.27|7.58
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|MVA [1690]|MVA OTHER-MRA [169000]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|83.27||||83.27|62.95|83.27|7.58
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|HORIZON [3625]|HORIZON FEDERAL [362504]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|83.27||||83.27|10.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|83.27||||83.27|49.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|83.27||||83.27|49.96|83.27|7.58
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 INDEMNITY [126019]|83.27||||83.27|45.8|83.27|7.58
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 HMO POS OPEN ACCESS [126018]|83.27||||83.27|45.8|83.27|7.58
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 SIGNATURE [101528]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|7.58|83.27|7.58
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|83.27||||83.27|37.47|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|83.27||||83.27|77.81|83.27|7.58
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|83.27||||83.27|66.61|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|83.27||||83.27|10.96|83.27|7.58
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]|EMPIRE BCBS HMO POS EPO [115558]|83.27||||83.27|77.81|83.27|7.58
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]|EMPIRE BCBS PPO [115559]|83.27||||83.27|77.81|83.27|7.58
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|83.27||||83.27|83.27|83.27|7.58
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.27||||83.27|70.78|83.27|7.58
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 COMMERCIAL [214001]|83.27||||83.27|49.13|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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 [137508]|83.27||||83.27|70.78|83.27|7.58
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>|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|83.27||||83.27|27.07|83.27|7.58
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.27||||83.27|70.78|83.27|7.58
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|83.27||||83.27|70.78|83.27|7.58
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.27||||83.27|49.13|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.27||||83.27|70.78|83.27|7.58
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|83.27||||83.27|77.81|83.27|7.58
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]|IHC HS [168011]|83.27||||83.27|70.78|83.27|7.58
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|83.27||||83.27|40.8|83.27|7.58
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|QUALCARE PPO [372503]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|83.27||||83.27|49.13|83.27|7.58
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|83.27||||83.27|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|83.27||||83.27|||
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|83.27||||83.27|||
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]|83.27||||83.27|||
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]|UNITED HEALTHCARE [206025]|83.27||||83.27|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.27||||83.27|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|83.27||||83.27|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|83.27||||83.27|||
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]|UNITED HEALTHCARE OXFORD [206009]|83.27||||83.27|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.27||||83.27|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|83.27||||83.27|||
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|83.27||||83.27|||
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|83.27||||83.27|||
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]|83.27||||83.27|||
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]|83.27||||83.27|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
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]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
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 [137508]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|564.2|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
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]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100192|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD49 MM ID28 MM HIP|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
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]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
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]|83.27||||83.27|83.27|83.27|7.58
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|83.27||||83.27|9.86|83.27|7.58
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|83.27||||83.27|83.27|83.27|7.58
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|GILSBAR [1425]|GILSBAR [142500]|83.27||||83.27|70.78|83.27|7.58
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]|GROUP HEALTH COOPERATIVE SCW [178012]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|83.27||||83.27|54.12|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|83.27||||83.27|9.86|83.27|7.58
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]|THE EMPIRE PLAN [206029]|83.27||||83.27|77.81|83.27|7.58
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|83.27||||83.27|70.78|83.27|7.58
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|MVA [1690]|MVA OTHER-MRA [169000]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON FEDERAL [362504]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|83.27||||83.27|62.95|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|83.27||||83.27|77.81|83.27|7.58
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]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|83.27||||83.27|10.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|83.27||||83.27|49.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|83.27||||83.27|49.96|83.27|7.58
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 HMO POS OPEN ACCESS [126018]|83.27||||83.27|45.8|83.27|7.58
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 INDEMNITY [126019]|83.27||||83.27|45.8|83.27|7.58
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 SIGNATURE [101528]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|7.58|83.27|7.58
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|83.27||||83.27|37.47|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.27||||83.27|83.27|83.27|7.58
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|83.27||||83.27|66.61|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|83.27||||83.27|10.96|83.27|7.58
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]|EMPIRE BCBS PPO [115559]|83.27||||83.27|77.81|83.27|7.58
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]|83.27||||83.27|27.07|83.27|7.58
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]|EMPIRE BCBS HMO POS EPO [115558]|83.27||||83.27|77.81|83.27|7.58
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|83.27||||83.27|83.27|83.27|7.58
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.27||||83.27|70.78|83.27|7.58
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 COMMERCIAL [214001]|83.27||||83.27|49.13|83.27|7.58
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 [137508]|83.27||||83.27|70.78|83.27|7.58
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>|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|83.27||||83.27|27.07|83.27|7.58
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.27||||83.27|70.78|83.27|7.58
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|83.27||||83.27|9.86|83.27|7.58
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|83.27||||83.27|70.78|83.27|7.58
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.27||||83.27|49.13|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.27||||83.27|70.78|83.27|7.58
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|83.27||||83.27|77.81|83.27|7.58
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]|IHC HS [168011]|83.27||||83.27|70.78|83.27|7.58
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|83.27||||83.27|40.8|83.27|7.58
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|QUALCARE PPO [372503]|83.27||||83.27|49.13|83.27|7.58
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|83.27||||83.27|49.13|83.27|7.58
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|83.27||||83.27|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|83.27||||83.27|||
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|83.27||||83.27|||
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]|83.27||||83.27|||
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]|UNITED HEALTHCARE [206025]|83.27||||83.27|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.27||||83.27|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|83.27||||83.27|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|83.27||||83.27|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.27||||83.27|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|83.27||||83.27|||
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]|UNITED HEALTHCARE OXFORD [206009]|83.27||||83.27|||
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|83.27||||83.27|||
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|83.27||||83.27|||
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]|83.27||||83.27|||
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]|83.27||||83.27|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
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]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100207|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 53MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
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 [137508]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
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]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
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]|564.20||||564.20|||
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]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100208|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR UHR COCR UHMWPE UNIVERSAL OD53 MM ID28 MM HIP|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA - ASA [141503]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|564.20||||564.20|66.82|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GILSBAR [1425]|GILSBAR [142500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|564.20||||564.20|310.31|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|564.20||||564.20|366.73|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|564.20||||564.20|66.82|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|564.20||||564.20|527.24|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MVA [1690]|MVA OTHER-MRA [169000]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|564.20||||564.20|527.24|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS UNION [362506]|564.20||||564.20|527.24|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|564.20||||564.20|426.54|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON FEDERAL [362504]|564.20||||564.20|527.24|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|564.20||||564.20|66.82|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|564.20||||564.20|74.25|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|564.20||||564.20|304.67|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|564.20||||564.20|304.67|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|564.20||||564.20|338.52|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|564.20||||564.20|338.52|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|564.20||||564.20|310.31|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA INDEMNITY [126019]|564.20||||564.20|310.31|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA SIGNATURE [101528]|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|51.34|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|564.20||||564.20|253.89|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|564.20||||564.20|451.36|564.2|51.34
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]|564.20||||564.20|310.31|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|WEB TPA [2115]|WEB TPA [211500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|564.20||||564.20|74.25|564.2|51.34
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]|564.20||||564.20|183.42|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|564.20||||564.20|527.24|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|EMPIRE BCBS PPO [115559]|564.20||||564.20|527.24|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|564.20||||564.20|332.88|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|564.20||||564.20|564.2|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|564.20||||564.20|183.42|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|TRUSTMARK [2030]|STARMARK [203000]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHNET [1495]|HEALTHNET [149500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|564.20||||564.20|66.82|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|564.20||||564.20|332.88|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|564.20||||564.20|479.57|564.2|51.34
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]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|564.20||||564.20|527.24|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|IHC HS [168011]|564.20||||564.20|479.57|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|564.20||||564.20|276.46|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|564.20||||564.20|332.88|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE PPO [372503]|564.20||||564.20|332.88|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|564.20||||564.20|332.88|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|564.20||||564.20|564.2|564.2|51.34
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|564.20||||564.20|||
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]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|564.20||||564.20|||
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]|564.20||||564.20|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|564.20||||564.20|||
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]|83.27||||83.27|70.78|83.27|7.58
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|83.27||||83.27|49.13|83.27|7.58
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|83.27||||83.27|70.78|83.27|7.58
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|83.27||||83.27|27.07|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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 [137508]|83.27||||83.27|70.78|83.27|7.58
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|83.27||||83.27|70.78|83.27|7.58
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]|EMPIRE BCBS HMO POS EPO [115558]|83.27||||83.27|77.81|83.27|7.58
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]|EMPIRE BCBS PPO [115559]|83.27||||83.27|77.81|83.27|7.58
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|83.27||||83.27|10.96|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|83.27||||83.27|66.61|83.27|7.58
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|83.27||||83.27|37.47|83.27|7.58
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]|83.27||||83.27|7.58|83.27|7.58
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 SIGNATURE [101528]|83.27||||83.27|83.27|83.27|7.58
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 HMO POS OPEN ACCESS [126018]|83.27||||83.27|45.8|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|83.27||||83.27|49.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|83.27||||83.27|44.96|83.27|7.58
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|83.27||||83.27|49.96|83.27|7.58
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|83.27||||83.27|10.96|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON [3625]|HORIZON FEDERAL [362504]|83.27||||83.27|77.81|83.27|7.58
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 INDEMNITY [126019]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|83.27||||83.27|83.27|83.27|7.58
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|83.27||||83.27|62.95|83.27|7.58
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|MVA [1690]|MVA OTHER-MRA [169000]|83.27||||83.27|83.27|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|27.07|83.27|7.58
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|83.27||||83.27|83.27|83.27|7.58
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 COMMERCIAL [214001]|83.27||||83.27|49.13|83.27|7.58
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|83.27||||83.27|70.78|83.27|7.58
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]|THE EMPIRE PLAN [206029]|83.27||||83.27|77.81|83.27|7.58
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>|83.27||||83.27|83.27|83.27|7.58
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|83.27||||83.27|54.12|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|83.27||||83.27|45.8|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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]|GROUP HEALTH COOPERATIVE SCW [178012]|83.27||||83.27|70.78|83.27|7.58
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|GILSBAR [1425]|GILSBAR [142500]|83.27||||83.27|70.78|83.27|7.58
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|83.27||||83.27|83.27|83.27|7.58
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|70.78|83.27|7.58
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|83.27||||83.27|9.86|83.27|7.58
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]|83.27||||83.27|83.27|83.27|7.58
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|83.27||||83.27|49.13|83.27|7.58
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|83.27||||83.27|83.27|83.27|7.58
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]|IHC HS [168011]|83.27||||83.27|70.78|83.27|7.58
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|83.27||||83.27|70.78|83.27|7.58
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|83.27||||83.27|49.13|83.27|7.58
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|83.27||||83.27|40.8|83.27|7.58
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|QUALCARE [3725]|QUALCARE PPO [372503]|83.27||||83.27|49.13|83.27|7.58
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|83.27||||83.27|77.81|83.27|7.58
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|83.27||||83.27|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|83.27||||83.27|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|83.27||||83.27|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|83.27||||83.27|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|83.27||||83.27|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|83.27||||83.27|||
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]|UNITED HEALTHCARE [206025]|83.27||||83.27|||
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]|UNITED HEALTHCARE OXFORD [206009]|83.27||||83.27|||
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]|83.27||||83.27|||
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|83.27||||83.27|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|83.27||||83.27|||
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|83.27||||83.27|||
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]|83.27||||83.27|||
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|83.27||||83.27|||
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]|83.27||||83.27|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA SIGNATURE [101528]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|46.06||||46.06|36.85|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|46.06||||46.06|25.34|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|46.06||||46.06|43.05|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|46.06||||46.06|20.73|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|46.06||||46.06|5.46|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|46.06||||46.06|29.94|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|QUALCARE [3725]|QUALCARE PPO [372503]|46.06||||46.06|27.18|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|46.06||||46.06|25.34|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|46.06||||46.06|6.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|46.06||||46.06|27.18|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.06||||46.06|27.18|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|BCBS [1155]|EMPIRE BCBS PPO [115559]|46.06||||46.06|43.05|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|46.06||||46.06|14.98|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HEALTHNET [1495]|HEALTHNET [149500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|46.06||||46.06|5.46|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|IHC HS [168011]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|46.06||||46.06|43.05|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|GILSBAR [1425]|GILSBAR [142500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|WEB TPA [2115]|WEB TPA [211500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.06||||46.06|14.98|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|46.06||||46.06|5.46|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|46.06||||46.06|24.87|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|46.06||||46.06|43.05|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.06||||46.06|5.46|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|46.06||||46.06|34.82|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS UNION [362506]|46.06||||46.06|43.05|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|TRUSTMARK [2030]|STARMARK [203000]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|46.06||||46.06|27.64|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|46.06||||46.06|24.87|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON FEDERAL [362504]|46.06||||46.06|43.05|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.06||||46.06|27.18|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|46.06||||46.06|6.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|46.06||||46.06|22.57|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MVA [1690]|MVA OTHER-MRA [169000]|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|46.06||||46.06|27.64|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|46.06||||46.06|46.06|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.06||||46.06|39.15|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|46.06||||46.06|25.34|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|46.06||||46.06|27.18|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.06||||46.06|4.19|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|46.06||||46.06|43.05|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA INDEMNITY [126019]|46.06||||46.06|25.34|46.06|4.19
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.06||||46.06|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|46.06||||46.06|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON [3625]|HORIZON BCBS UNION [362506]|273.00||||273.00|255.12|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|273.00||||273.00|206.39|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHNET [1495]|HEALTHNET [149500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|273.00||||273.00|161.07|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON [3625]|HORIZON FEDERAL [362504]|273.00||||273.00|255.12|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|273.00||||273.00|88.75|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|QUALCARE [3725]|QUALCARE PPO [372503]|273.00||||273.00|161.07|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|273.00||||273.00|150.15|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|273.00||||273.00|255.12|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|<Self-pay>|<Self-pay>|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|273.00||||273.00|177.45|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MULTIPLAN [1680]|IHC HS [168011]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|273.00||||273.00|255.12|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MVA [1690]|MVA OTHER-MRA [169000]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|273.00||||273.00|122.85|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|273.00||||273.00|32.33|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|273.00||||273.00|161.07|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|GEHA [1415]|GEHA - ASA [141503]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|273.00||||273.00|32.33|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|273.00||||273.00|150.15|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|273.00||||273.00|147.42|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|273.00||||273.00|163.8|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|GILSBAR [1425]|GILSBAR [142500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|273.00||||273.00|255.12|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|273.00||||273.00|255.12|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|TRUSTMARK [2030]|STARMARK [203000]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|273.00||||273.00|35.93|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|273.00||||273.00|163.8|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|EMPIRE BCBS PPO [115559]|273.00||||273.00|255.12|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|273.00||||273.00|218.4|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|273.00||||273.00|150.15|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|273.00||||273.00|35.93|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CIGNA [1260]|CIGNA INDEMNITY [126019]|273.00||||273.00|150.15|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|273.00||||273.00|88.75|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|273.00||||273.00|161.07|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|273.00||||273.00|133.77|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA [1015]|AETNA SIGNATURE [101528]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|WEB TPA [2115]|WEB TPA [211500]|273.00||||273.00|232.05|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|273.00||||273.00|147.42|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|273.00||||273.00|32.33|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|273.00||||273.00|32.33|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|273.00||||273.00|273|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|273.00||||273.00|24.84|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|273.00||||273.00|161.07|273|24.84
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|273.00||||273.00|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|273.00||||273.00|||
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.06||||46.06|5.46|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|46.06||||46.06|46.06|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|46.06||||46.06|43.05|46.06|4.19
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|46.06||||46.06|20.73|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|46.06||||46.06|27.64|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|4.19|46.06|4.19
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]|THE EMPIRE PLAN [206029]|46.06||||46.06|43.05|46.06|4.19
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 INDEMNITY [126019]|46.06||||46.06|25.34|46.06|4.19
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|46.06||||46.06|5.46|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|46.06||||46.06|27.64|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|46.06||||46.06|24.87|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|46.06||||46.06|24.87|46.06|4.19
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|46.06||||46.06|5.46|46.06|4.19
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|46.06||||46.06|25.34|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|14.98|46.06|4.19
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|46.06||||46.06|29.94|46.06|4.19
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|46.06||||46.06|36.85|46.06|4.19
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.06||||46.06|46.06|46.06|4.19
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 HMO POS OPEN ACCESS [126018]|46.06||||46.06|25.34|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|46.06||||46.06|34.82|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|46.06||||46.06|46.06|46.06|4.19
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 SIGNATURE [101528]|46.06||||46.06|46.06|46.06|4.19
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 COMMERCIAL [214001]|46.06||||46.06|27.18|46.06|4.19
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|46.06||||46.06|6.06|46.06|4.19
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|46.06||||46.06|6.06|46.06|4.19
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|46.06||||46.06|46.06|46.06|4.19
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|HORIZON [3625]|HORIZON FEDERAL [362504]|46.06||||46.06|43.05|46.06|4.19
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|46.06||||46.06|5.46|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|46.06||||46.06|43.05|46.06|4.19
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]|46.06||||46.06|46.06|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|46.06||||46.06|43.05|46.06|4.19
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|MVA [1690]|MVA OTHER-MRA [169000]|46.06||||46.06|46.06|46.06|4.19
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]|GROUP HEALTH COOPERATIVE SCW [178012]|46.06||||46.06|39.15|46.06|4.19
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|46.06||||46.06|27.18|46.06|4.19
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]|EMPIRE BCBS HMO POS EPO [115558]|46.06||||46.06|43.05|46.06|4.19
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.06||||46.06|39.15|46.06|4.19
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|46.06||||46.06|22.57|46.06|4.19
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.06||||46.06|27.18|46.06|4.19
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|46.06||||46.06|27.18|46.06|4.19
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|46.06||||46.06|14.98|46.06|4.19
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.06||||46.06|39.15|46.06|4.19
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>|46.06||||46.06|46.06|46.06|4.19
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.06||||46.06|39.15|46.06|4.19
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|QUALCARE [3725]|QUALCARE PPO [372503]|46.06||||46.06|27.18|46.06|4.19
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]|46.06||||46.06|46.06|46.06|4.19
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|46.06||||46.06|46.06|46.06|4.19
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.06||||46.06|39.15|46.06|4.19
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|GILSBAR [1425]|GILSBAR [142500]|46.06||||46.06|39.15|46.06|4.19
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]|IHC HS [168011]|46.06||||46.06|39.15|46.06|4.19
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]|EMPIRE BCBS PPO [115559]|46.06||||46.06|43.05|46.06|4.19
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]|46.06||||46.06|25.34|46.06|4.19
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 [137508]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|46.06||||46.06|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|46.06||||46.06|||
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]|46.06||||46.06|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|46.06||||46.06|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|46.06||||46.06|||
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|46.06||||46.06|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.06||||46.06|||
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]|UNITED HEALTHCARE [206025]|46.06||||46.06|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|46.06||||46.06|||
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]|46.06||||46.06|||
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|46.06||||46.06|||
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]|46.06||||46.06|||
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]|UNITED HEALTHCARE OXFORD [206009]|46.06||||46.06|||
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|46.06||||46.06|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.06||||46.06|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|QUALCARE [3725]|QUALCARE HMO/POS [372501]|13155.25||||13155.25|12563.26|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|13155.25||||13155.25|1558.11|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|BCBS [1155]|EMPIRE BCBS PPO [115559]|13155.25||||13155.25|12293.58|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13155.25||||13155.25|12563.26|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|13155.25||||13155.25|5608.08|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|13155.25||||13155.25|12293.58|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|13155.25||||13155.25|11037.25|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|13155.25||||13155.25|12293.58|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|13155.25||||13155.25|1731.23|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|QUALCARE [3725]|QUALCARE PPO [372503]|13155.25||||13155.25|12563.26|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|13155.25||||13155.25|13155.25|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|13155.25||||13155.25|6446.07|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HEALTHNET [1495]|HEALTHNET [149500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|13155.25||||13155.25|4735.89|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|13155.25||||13155.25|5608.08|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13155.25||||13155.25|1197.13|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|13155.25||||13155.25|4276.77|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|<Self-pay>|<Self-pay>|13155.25||||13155.25|13155.25|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON [3625]|HORIZON FEDERAL [362504]|13155.25||||13155.25|12293.58|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|CIGNA [1260]|CIGNA INDEMNITY [126019]|13155.25||||13155.25|3815.02|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|13155.25||||13155.25|4735.89|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|13155.25||||13155.25|5919.86|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|13155.25||||13155.25|12293.58|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON [3625]|HORIZON BCBS UNION [362506]|13155.25||||13155.25|12293.58|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|13155.25||||13155.25|3815.02|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|GEHA [1415]|GEHA - ASA [141503]|13155.25||||13155.25|5608.08|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|13155.25||||13155.25|5262.1|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13155.25||||13155.25|5608.08|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|WEB TPA [2115]|WEB TPA [211500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MVA [1690]|MVA OTHER-MRA [169000]|13155.25||||13155.25|13155.25|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|13155.25||||13155.25|5262.1|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|13155.25||||13155.25|9945.37|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|13155.25||||13155.25|11666.08|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AETNA [1015]|AETNA SIGNATURE [101528]|13155.25||||13155.25|5608.08|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|TRUSTMARK [2030]|STARMARK [203000]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|13155.25||||13155.25|7235.39|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|13155.25||||13155.25|8550.91|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13155.25||||13155.25|4276.77|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|13155.25||||13155.25|3815.02|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|13155.25||||13155.25|1558.11|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MULTIPLAN [1680]|IHC HS [168011]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|13155.25||||13155.25|5608.08|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|13155.25||||13155.25|3815.02|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|GILSBAR [1425]|GILSBAR [142500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|13155.25||||13155.25|2181.1|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|13155.25||||13155.25|1731.23|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|13155.25||||13155.25|1558.11|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|13155.25||||13155.25|1558.11|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|13155.25||||13155.25|12563.26|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|13155.25||||13155.25|12293.58|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|13155.25||||13155.25|11181.96|13155.25|1197.13
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UMR [2035]|UMR UNITED HEALTHCARE [203502]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|13155.25||||13155.25|||
100272|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|C1 ESTERASE INHIBITOR 500 UNIT (10 ML) INTRAVENOUS KIT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13155.25||||13155.25|||
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.06||||46.06|46.06|46.06|4.19
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|46.06||||46.06|46.06|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|46.06||||46.06|5.46|46.06|4.19
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]|46.06||||46.06|46.06|46.06|4.19
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|GILSBAR [1425]|GILSBAR [142500]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|46.06||||46.06|24.87|46.06|4.19
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 HMO POS OPEN ACCESS [126018]|46.06||||46.06|25.34|46.06|4.19
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|46.06||||46.06|27.18|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|46.06||||46.06|43.05|46.06|4.19
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]|46.06||||46.06|4.19|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|14.98|46.06|4.19
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]|46.06||||46.06|46.06|46.06|4.19
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|46.06||||46.06|36.85|46.06|4.19
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 INDEMNITY [126019]|46.06||||46.06|25.34|46.06|4.19
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|46.06||||46.06|6.06|46.06|4.19
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|46.06||||46.06|22.57|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|46.06||||46.06|34.82|46.06|4.19
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|46.06||||46.06|27.18|46.06|4.19
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|46.06||||46.06|5.46|46.06|4.19
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|QUALCARE [3725]|QUALCARE PPO [372503]|46.06||||46.06|27.18|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|GROUP HEALTH COOPERATIVE SCW [178012]|46.06||||46.06|39.15|46.06|4.19
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|HORIZON [3625]|HORIZON FEDERAL [362504]|46.06||||46.06|43.05|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|46.06||||46.06|43.05|46.06|4.19
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|MVA [1690]|MVA OTHER-MRA [169000]|46.06||||46.06|46.06|46.06|4.19
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]|IHC HS [168011]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|46.06||||46.06|27.64|46.06|4.19
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|46.06||||46.06|43.05|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.06||||46.06|27.18|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|46.06||||46.06|14.98|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 [137508]|46.06||||46.06|39.15|46.06|4.19
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|46.06||||46.06|27.64|46.06|4.19
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 COMMERCIAL [214001]|46.06||||46.06|27.18|46.06|4.19
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]|EMPIRE BCBS PPO [115559]|46.06||||46.06|43.05|46.06|4.19
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]|EMPIRE BCBS HMO POS EPO [115558]|46.06||||46.06|43.05|46.06|4.19
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>|46.06||||46.06|46.06|46.06|4.19
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|46.06||||46.06|5.46|46.06|4.19
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.06||||46.06|39.15|46.06|4.19
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|46.06||||46.06|6.06|46.06|4.19
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 SIGNATURE [101528]|46.06||||46.06|46.06|46.06|4.19
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.06||||46.06|39.15|46.06|4.19
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]|THE EMPIRE PLAN [206029]|46.06||||46.06|43.05|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|46.06||||46.06|46.06|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|46.06||||46.06|25.34|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|46.06||||46.06|24.87|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|46.06||||46.06|46.06|46.06|4.19
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|46.06||||46.06|29.94|46.06|4.19
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|46.06||||46.06|46.06|46.06|4.19
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.06||||46.06|5.46|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|46.06||||46.06|20.73|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|25.34|46.06|4.19
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|46.06||||46.06|||
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|46.06||||46.06|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|46.06||||46.06|||
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]|UNITED HEALTHCARE OXFORD [206009]|46.06||||46.06|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.06||||46.06|||
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|46.06||||46.06|||
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]|46.06||||46.06|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|46.06||||46.06|||
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|46.06||||46.06|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.06||||46.06|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|46.06||||46.06|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|46.06||||46.06|||
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]|UNITED HEALTHCARE [206025]|46.06||||46.06|||
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]|46.06||||46.06|||
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]|46.06||||46.06|||
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|QUALCARE [3725]|QUALCARE PPO [372503]|46.06||||46.06|27.18|46.06|4.19
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|QUALCARE [3725]|QUALCARE HMO/POS [372501]|46.06||||46.06|27.18|46.06|4.19
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|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|46.06||||46.06|43.05|46.06|4.19
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]|IHC HS [168011]|46.06||||46.06|39.15|46.06|4.19
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|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|46.06||||46.06|27.18|46.06|4.19
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|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.06||||46.06|46.06|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|46.06|46.06|4.19
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|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|46.06||||46.06|46.06|46.06|4.19
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|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.06||||46.06|27.18|46.06|4.19
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]|EMPIRE BCBS HMO POS EPO [115558]|46.06||||46.06|43.05|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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>|46.06||||46.06|46.06|46.06|4.19
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|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|46.06||||46.06|27.64|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|46.06||||46.06|46.06|46.06|4.19
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]|GROUP HEALTH COOPERATIVE SCW [178012]|46.06||||46.06|39.15|46.06|4.19
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|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|46.06||||46.06|5.46|46.06|4.19
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 JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|46.06||||46.06|6.06|46.06|4.19
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]|46.06||||46.06|4.19|46.06|4.19
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|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|46.06||||46.06|36.85|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 SIGNATURE [101528]|46.06||||46.06|46.06|46.06|4.19
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|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|46.06||||46.06|27.64|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|46.06||||46.06|24.87|46.06|4.19
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 INDEMNITY [126019]|46.06||||46.06|25.34|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 HMO POS OPEN ACCESS [126018]|46.06||||46.06|25.34|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|14.98|46.06|4.19
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|MVA [1690]|MVA OTHER-MRA [169000]|46.06||||46.06|46.06|46.06|4.19
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|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 [137508]|46.06||||46.06|39.15|46.06|4.19
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|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|46.06||||46.06|29.94|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|46.06||||46.06|43.05|46.06|4.19
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]|THE EMPIRE PLAN [206029]|46.06||||46.06|43.05|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|46.06||||46.06|20.73|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|46.06||||46.06|24.87|46.06|4.19
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|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|46.06||||46.06|25.34|46.06|4.19
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]|46.06||||46.06|25.34|46.06|4.19
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|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.06||||46.06|5.46|46.06|4.19
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|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.06||||46.06|39.15|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|46.06||||46.06|46.06|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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|HORIZON [3625]|HORIZON FEDERAL [362504]|46.06||||46.06|43.05|46.06|4.19
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|GILSBAR [1425]|GILSBAR [142500]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|46.06||||46.06|5.46|46.06|4.19
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|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|46.06||||46.06|6.06|46.06|4.19
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|46.06||||46.06|46.06|46.06|4.19
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]|EMPIRE BCBS PPO [115559]|46.06||||46.06|43.05|46.06|4.19
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|46.06||||46.06|14.98|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS UNION [362506]|46.06||||46.06|43.05|46.06|4.19
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|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|46.06||||46.06|34.82|46.06|4.19
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]|46.06||||46.06|39.15|46.06|4.19
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|46.06||||46.06|22.57|46.06|4.19
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|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.06||||46.06|39.15|46.06|4.19
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]|46.06||||46.06|46.06|46.06|4.19
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|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|46.06||||46.06|5.46|46.06|4.19
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 COMMERCIAL [214001]|46.06||||46.06|27.18|46.06|4.19
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|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|46.06||||46.06|||
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]|46.06||||46.06|||
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|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|46.06||||46.06|||
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|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|46.06||||46.06|||
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|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|46.06||||46.06|||
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|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|46.06||||46.06|||
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|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.06||||46.06|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|46.06||||46.06|||
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]|UNITED HEALTHCARE [206025]|46.06||||46.06|||
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|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.06||||46.06|||
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]|UNITED HEALTHCARE OXFORD [206009]|46.06||||46.06|||
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]|46.06||||46.06|||
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]|46.06||||46.06|||
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|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|46.06||||46.06|||
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|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|46.06||||46.06|||
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]|IHC HS [168011]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|QUALCARE [3725]|QUALCARE HMO/POS [372501]|2469.74||||2469.74|1457.15|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|QUALCARE [3725]|QUALCARE PPO [372503]|2469.74||||2469.74|1457.15|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|2469.74||||2469.74|1457.15|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2469.74||||2469.74|1210.17|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|2469.74||||2469.74|2307.97|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2469.74||||2469.74|1457.15|2469.74|224.75
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]|2469.74||||2469.74|2469.74|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|2469.74||||2469.74|2469.74|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2469.74||||2469.74|2099.28|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MVA [1690]|MVA OTHER-MRA [169000]|2469.74||||2469.74|2469.74|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
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]|2469.74||||2469.74|802.91|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|2469.74||||2469.74|292.52|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2469.74||||2469.74|987.9|2469.74|224.75
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]|2469.74||||2469.74|2469.74|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2469.74||||2469.74|292.52|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|2469.74||||2469.74|1605.33|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON [3625]|HORIZON FEDERAL [362504]|2469.74||||2469.74|2307.97|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS UNION [362506]|2469.74||||2469.74|2307.97|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|2469.74||||2469.74|2307.97|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2469.74||||2469.74|292.52|2469.74|224.75
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 SIGNATURE [101528]|2469.74||||2469.74|2469.74|2469.74|224.75
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]|2469.74||||2469.74|224.75|2469.74|224.75
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]|2469.74||||2469.74|1358.36|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|2469.74||||2469.74|1333.66|2469.74|224.75
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 HMO POS OPEN ACCESS [126018]|2469.74||||2469.74|1358.36|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|2469.74||||2469.74|1111.38|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|2469.74||||2469.74|1481.84|2469.74|224.75
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 INDEMNITY [126019]|2469.74||||2469.74|1358.36|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|2469.74||||2469.74|2469.74|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|2469.74||||2469.74|1333.66|2469.74|224.75
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]|THE EMPIRE PLAN [206029]|2469.74||||2469.74|2307.97|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|2469.74||||2469.74|1358.36|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|2469.74||||2469.74|325.02|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|2469.74||||2469.74|1481.84|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|2469.74||||2469.74|2469.74|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|2469.74||||2469.74|1867.12|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2469.74||||2469.74|325.02|2469.74|224.75
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 [137508]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|2469.74||||2469.74|1975.79|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2469.74||||2469.74|2469.74|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|2469.74||||2469.74|2469.74|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|GILSBAR [1425]|GILSBAR [142500]|2469.74||||2469.74|2099.28|2469.74|224.75
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 COMMERCIAL [214001]|2469.74||||2469.74|1457.15|2469.74|224.75
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]|EMPIRE BCBS PPO [115559]|2469.74||||2469.74|2307.97|2469.74|224.75
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]|EMPIRE BCBS HMO POS EPO [115558]|2469.74||||2469.74|2307.97|2469.74|224.75
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>|2469.74||||2469.74|2469.74|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
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]|GROUP HEALTH COOPERATIVE SCW [178012]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|2469.74||||2469.74|802.91|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
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]|2469.74||||2469.74|2099.28|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2469.74||||2469.74|292.52|2469.74|224.75
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2469.74||||2469.74|2099.28|2469.74|224.75
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]|2469.74||||2469.74|||
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]|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|2469.74||||2469.74|||
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]|UNITED HEALTHCARE [206025]|2469.74||||2469.74|||
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]|UNITED HEALTHCARE OXFORD [206009]|2469.74||||2469.74|||
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]|2469.74||||2469.74|||
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]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2469.74||||2469.74|||
100296|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 2 39 MM OFFSET L124 MM HIP CEMENT|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|2469.74||||2469.74|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|QUALCARE [3725]|QUALCARE PPO [372503]|46.06||||46.06|27.18|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|46.06||||46.06|25.34|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|46.06||||46.06|6.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|46.06||||46.06|24.87|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|46.06||||46.06|27.18|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|QUALCARE [3725]|QUALCARE HMO/POS [372501]|46.06||||46.06|27.18|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|WEB TPA [2115]|WEB TPA [211500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|46.06||||46.06|27.18|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|TRUSTMARK [2030]|STARMARK [203000]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|IHC HS [168011]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|46.06||||46.06|27.18|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|EMPIRE BCBS PPO [115559]|46.06||||46.06|43.05|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|46.06||||46.06|6.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|46.06||||46.06|14.98|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|46.06||||46.06|36.85|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|46.06||||46.06|20.73|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|46.06||||46.06|43.05|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|46.06||||46.06|4.19|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|46.06||||46.06|43.05|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA INDEMNITY [126019]|46.06||||46.06|25.34|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|46.06||||46.06|24.87|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|46.06||||46.06|27.64|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|46.06||||46.06|27.64|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|46.06||||46.06|34.82|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS UNION [362506]|46.06||||46.06|43.05|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|46.06||||46.06|43.05|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON FEDERAL [362504]|46.06||||46.06|43.05|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|46.06||||46.06|25.34|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|46.06||||46.06|29.94|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MVA [1690]|MVA OTHER-MRA [169000]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GILSBAR [1425]|GILSBAR [142500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|46.06||||46.06|5.46|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|46.06||||46.06|5.46|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHFIRST [2395]|HEALTHFIRST [239500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|46.06||||46.06|22.57|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|46.06||||46.06|25.34|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA SIGNATURE [101528]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|46.06||||46.06|5.46|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|46.06||||46.06|14.98|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHNET [1495]|HEALTHNET [149500]|46.06||||46.06|39.15|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|46.06||||46.06|46.06|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|46.06||||46.06|43.05|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|46.06||||46.06|5.46|46.06|4.19
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UMR UNITED HEALTHCARE [203502]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|46.06||||46.06|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|46.06||||46.06|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2469.74||||2469.74|987.9|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2469.74||||2469.74|292.52|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AETNA [1015]|AETNA SIGNATURE [101528]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|2469.74||||2469.74|1111.38|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|BCBS [1155]|EMPIRE BCBS PPO [115559]|2469.74||||2469.74|2307.97|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|WEB TPA [2115]|WEB TPA [211500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2469.74||||2469.74|1457.15|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|2469.74||||2469.74|802.91|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|FIRST HEALTH [1375]|TALL TREE ADMINISTRATORS [137508]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|2469.74||||2469.74|2307.97|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2469.74||||2469.74|325.02|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|2469.74||||2469.74|1975.79|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2469.74||||2469.74|224.75|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|GEHA [1415]|GEHA - ASA [141503]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|2469.74||||2469.74|1358.36|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2469.74||||2469.74|292.52|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|TRUSTMARK [2030]|STARMARK [203000]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|2469.74||||2469.74|1481.84|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|2469.74||||2469.74|1333.66|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|2469.74||||2469.74|1358.36|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON [3625]|HORIZON FEDERAL [362504]|2469.74||||2469.74|2307.97|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MVA [1690]|MVA OTHER-MRA [169000]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|2469.74||||2469.74|292.52|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|2469.74||||2469.74|2307.97|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2469.74||||2469.74|802.91|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS UNION [362506]|2469.74||||2469.74|2307.97|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2469.74||||2469.74|2307.97|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2469.74||||2469.74|1358.36|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2469.74||||2469.74|292.52|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|2469.74||||2469.74|1605.33|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|2469.74||||2469.74|325.02|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|2469.74||||2469.74|1333.66|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|GILSBAR [1425]|GILSBAR [142500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HEALTHNET [1495]|HEALTHNET [149500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|2469.74||||2469.74|1481.84|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|CIGNA [1260]|CIGNA INDEMNITY [126019]|2469.74||||2469.74|1358.36|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2469.74||||2469.74|1457.15|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2469.74||||2469.74|1210.17|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|2469.74||||2469.74|1867.12|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|2469.74||||2469.74|2307.97|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|<Self-pay>|<Self-pay>|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MULTIPLAN [1680]|IHC HS [168011]|2469.74||||2469.74|2099.28|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|2469.74||||2469.74|1457.15|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|QUALCARE [3725]|QUALCARE PPO [372503]|2469.74||||2469.74|1457.15|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|QUALCARE [3725]|QUALCARE HMO/POS [372501]|2469.74||||2469.74|1457.15|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2469.74||||2469.74|2469.74|2469.74|224.75
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON NJ TOTALCARE (HMO SNP) [363003]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AHCA SELF PAY [3515]|AHCA SELF PAY [351500]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|NJDDC SELF PAY [3700]|NJDDCS SELF PAY [370000]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|OB / BARIATRIC PAYOR [3805]|OB / BARIATRIC SELF PAY [380501]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA ADVANTAGE PLAN [152500]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE OXFORD [206009]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|CLIENT ACCOUNT [3500]|CLIENT ACCOUNT PLAN [350000]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UNITED HEALTHCARE DUAL COMPL [206505], UHC MEDICAR|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|THCIC SELF PAY [2215]|THCIC SELF PAY [221500]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|UMR [2035]|UMR UNITED HEALTHCARE [203502]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2469.74||||2469.74|||
100300|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 4 46 MM OFFSET L137 MM HIP CEMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE HMO ADVANTAGE [102001]|2469.74||||2469.74|||
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2469.74||||2469.74|1210.17|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|QUALCARE [3725]|QUALCARE PPO [372503]|2469.74||||2469.74|1457.15|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|QUALCARE [3725]|QUALCARE HMO/POS [372501]|2469.74||||2469.74|1457.15|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|QUALCARE [3725]|OSCAR HEALTH NJ [372505]|2469.74||||2469.74|1457.15|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|ANTHEM BLUE CROSS BLUE SHIELD [3525]|ANTHEM BLUE CROSS BLUE SHIELD [352500]|2469.74||||2469.74|2307.97|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2469.74||||2469.74|1457.15|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|<Self-pay>|<Self-pay>|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|WEB TPA [2115]|WEB TPA [211500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED HMO/POS [352007]|2469.74||||2469.74|1481.84|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH PREFERRED PPO [352009]|2469.74||||2469.74|1481.84|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|AETNA [1015]|AETNA SIGNATURE [101528]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MAYO CLINIC HEALTH SOLUTIONS [2280]|MAYO CLINIC HEALTH SOLUTIONS [228000]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|CIGNA [1260]|CIGNA HMO POS OPEN ACCESS [126018]|2469.74||||2469.74|1358.36|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH VALUE HMO [352010]|2469.74||||2469.74|1333.66|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS NJ OMNIA [362502]|2469.74||||2469.74|1867.12|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS INDEMNITY [362501]|2469.74||||2469.74|2307.97|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|TRUSTMARK [2030]|STARMARK [203000]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS UNION [362506]|2469.74||||2469.74|2307.97|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|CLOVER HEALTH MEDICARE REPLACEMENT [3795]|CLOVER HEALTH MEDICARE REPLACEMENT [379500]|2469.74||||2469.74|1111.38|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HORIZON [3625]|HORIZON BCBS STATE EMPLOYEES PLAN (SHBP) [362509]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MVA [1690]|MVA OTHER-MRA [169000]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|AMERIHEALTH [3520]|AMERIHEALTH VALUE PPO [352011]|2469.74||||2469.74|1333.66|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|UHC MEDICAID REPLACEMENT [3755]|UHCCP [375500]|2469.74||||2469.74|292.52|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HEALTHCARE HIGHWAYS [2210]|HEALTH PLANS INC [221008]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|UNITED HEALTHCARE [2060]|THE EMPIRE PLAN [206029]|2469.74||||2469.74|2307.97|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HEALTHFIRST [2395]|HEALTHFIRST [239500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MAGNACARE COMMERCIAL [3650]|MAGNACARE COMMERCIAL [365000]|2469.74||||2469.74|1605.33|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|NEW JERSEY MEDICAID [3675]|MEDICAID PRESUMPTIVE ELIGIBILITY NJ [367502]|2469.74||||2469.74|325.02|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|CIGNA [1260]|CIGNA INDEMNITY [126019]|2469.74||||2469.74|1358.36|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HEALTHNET [1495]|HEALTHNET [149500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|PHCS [1780]|GROUP HEALTH COOPERATIVE SCW [178012]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|NIPPON LIFE INS CO [3695]|NIPPON LIFE INS CO [369500]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2469.74||||2469.74|292.52|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HOMETOWN HEALTH [2155]|HOMETOWN HEALTH [215500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|GEHA [1415]|GEHA - ASA [141503]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2469.74||||2469.74|224.75|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HEALTHCOST SOLUTIONS [2415]|HEALTHCOST SOLUTIONS [241501]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|COMMERCIAL GENERIC [1285]|COMMERCIAL OTHER [128501]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|FIDELIS CARE OF NY MEDICAID REPLACEMENT [3865]|FIDELIS CARE OF NY MEDICAID REPLACEMENT [386500]|2469.74||||2469.74|325.02|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|BCBS [1155]|EMPIRE BCBS HMO POS EPO [115558]|2469.74||||2469.74|2307.97|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|BCBS [1155]|EMPIRE BCBS PPO [115559]|2469.74||||2469.74|2307.97|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2469.74||||2469.74|292.52|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2469.74||||2469.74|2469.74|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HEALTHFIRST MEDICAID [3870]|HEALTHFIRST MEDICAID [387000]|2469.74||||2469.74|292.52|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MVP HEALTH PLAN [2180]|MVP HEALTH PLAN [218500]|2469.74||||2469.74|1358.36|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|GILSBAR [1425]|GILSBAR [142500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|MULTIPLAN [1680]|IHC HS [168011]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|CREATE FLEX / SELECT [3580]|CREATE FLEX CARE [358000]|2469.74||||2469.74|1975.79|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HORIZON [3625]|HORIZON FEDERAL [362504]|2469.74||||2469.74|2307.97|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2469.74||||2469.74|1358.36|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HORIZON BCBS MEDICARE REPLACEMENT [3630]|HORIZON HEALTHCARE OF NJ [363002]|2469.74||||2469.74|802.91|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2469.74||||2469.74|802.91|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|EMBLEM HEALTH [2430]|EMBLEM HEALTH [243001]|2469.74||||2469.74|1457.15|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|HORIZON NJ HEALTH [3635]|HORIZON NJ HEALTH [363500]|2469.74||||2469.74|987.9|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 5 48 MM OFFSET L145 MM HIP CEMENT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2469.74||||2469.74|2099.28|2469.74|224.75
100302|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEV