"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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4050.01||||4050.01|2940.31|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|4050.01||||4050.01|2308.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GILSBAR [1425]|GILSBAR [142500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|4050.01||||4050.01|2025.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|4050.01||||4050.01|2944.36|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA TRS [101506]|4050.01||||4050.01|2632.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4050.01||||4050.01|2940.31|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4050.01||||4050.01|2632.51|3442.51|466.56
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]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4050.01||||4050.01|1349.87|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|PHCS MULTIPLAN [178000]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|4050.01||||4050.01|3442.51|3442.51|466.56
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]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR CHOICE [203500]|4050.01||||4050.01|2482.66|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GUARDIAN [1465]|GUARDIAN [146500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|4050.01||||4050.01|1417.5|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MEDICA [2910]|MEDICA HARMONY [291000]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|4050.01||||4050.01|466.56|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|4050.01||||4050.01|1701|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA [126008]|4050.01||||4050.01|2940.31|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|4050.01||||4050.01|466.56|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PHCS [1780]|FREEDOM LIFE [178009]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|4050.01||||4050.01|1255.5|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TDH BCCS [2341]|TDH BCCS [234100]|4050.01||||4050.01|466.56|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|4050.01||||4050.01|1944.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|EQUITABLE [1355]|EQUITABLE INS [135500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR CORE [203505]|4050.01||||4050.01|1733.4|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|4050.01||||4050.01|783.68|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|WEB TPA [2115]|WEB TPA [211500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|4050.01||||4050.01|466.56|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|4050.01||||4050.01|2430.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TRUSTMARK [2030]|STARMARK [203000]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|WEB TPA [2115]|WEB TPA [211501]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CORESOURCE [1315]|CORESOURCE [131500]|4050.01||||4050.01|2940.31|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|4050.01||||4050.01|2025.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|4050.01||||4050.01|2025.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4050.01||||4050.01|2025.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|4050.01||||4050.01|1701|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|4050.01||||4050.01|1701|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TML [1980]|TML [198000]|4050.01||||4050.01|2482.66|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NRECA [1735]|NRECA [173500]|4050.01||||4050.01|2482.66|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|4050.01||||4050.01|2308.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FMH BENEFIT SERVICES [1390]|FMH [139000]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|4050.01||||4050.01|2482.66|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4050.01||||4050.01|2482.66|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|4050.01||||4050.01|2065.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|4050.01||||4050.01|1903.5|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA PANTEX [126003]|4050.01||||4050.01|1903.5|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR OPTIONS [203501]|4050.01||||4050.01|2944.36|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHNET [1495]|HEALTHNET [149500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CBSA [1215]|CBSA [121500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|4050.01||||4050.01|3442.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4050.01||||4050.01|881.69|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|4050.01||||4050.01|2835.01|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|4050.01||||4050.01|3037.51|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|4050.01||||4050.01|783.68|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4050.01||||4050.01|2940.31|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|4050.01||||4050.01|1733.4|3442.51|466.56
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4050.01||||4050.01|||
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]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UMR CHEROKEE MLR [203504]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|4050.01||||4050.01|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|4050.01||||4050.01|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|696.97|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1317.1|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|<Self-pay>|<Self-pay>|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6050.05||||6050.05|3708.68|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|1170.68|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|6050.05||||6050.05|1875.52|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|6050.05||||6050.05|3025.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|6050.05||||6050.05|3025.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|1170.68|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6050.05||||6050.05|696.97|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA TRS [101506]|6050.05||||6050.05|3932.53|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TDH BCCS [2341]|TDH BCCS [234100]|6050.05||||6050.05|696.97|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|696.97|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|6050.05||||6050.05|5142.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|696.97
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|CHAMPVA [1240]|CHAMP VA [124000]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05|||
100019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 4 33 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|<Self-pay>|<Self-pay>|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|696.97|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|1170.68|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|6050.05||||6050.05|3025.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6050.05||||6050.05|3708.68|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6050.05||||6050.05|696.97|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|6050.05||||6050.05|1875.52|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA TRS [101506]|6050.05||||6050.05|3932.53|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1317.1|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TDH BCCS [2341]|TDH BCCS [234100]|6050.05||||6050.05|696.97|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|696.97|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|6050.05||||6050.05|3025.02|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|1170.68|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|696.97
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CHAMPVA [1240]|CHAMP VA [124000]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05|||
100022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 127 D 7 45 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|696.97|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|1170.68|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|6050.05||||6050.05|1875.52|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1317.1|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|6050.05||||6050.05|3025.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|6050.05||||6050.05|3025.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|696.97|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|1170.68|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TDH BCCS [2341]|TDH BCCS [234100]|6050.05||||6050.05|696.97|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6050.05||||6050.05|3708.68|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA TRS [101506]|6050.05||||6050.05|3932.53|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6050.05||||6050.05|696.97|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|696.97
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05|||
100027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 4 29 MM OFFSET L100 MM OD8.1 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6050.05||||6050.05|3708.68|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA TRS [101506]|6050.05||||6050.05|3932.53|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|1170.68|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|6050.05||||6050.05|3025.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|696.97|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6050.05||||6050.05|696.97|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TDH BCCS [2341]|TDH BCCS [234100]|6050.05||||6050.05|696.97|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|6050.05||||6050.05|1875.52|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|6050.05||||6050.05|3025.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|1170.68|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|696.97|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1317.1|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|696.97
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05|||
100030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 7 35 MM OFFSET L130 MM OD10.4 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|6050.05||||6050.05|2843.52|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131500]|6050.05||||6050.05|4392.34|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6050.05||||6050.05|4392.34|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|EQUITABLE [1355]|EQUITABLE INS [135500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|6050.05||||6050.05|1170.68|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|6050.05||||6050.05|3025.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CHOICE [203500]|6050.05||||6050.05|3708.68|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|6050.05||||6050.05|2541.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TML [1980]|TML [198000]|6050.05||||6050.05|3708.68|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6050.05||||6050.05|3932.53|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6050.05||||6050.05|1317.1|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CBSA [1215]|CBSA [121500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR OPTIONS [203501]|6050.05||||6050.05|4398.39|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FMH BENEFIT SERVICES [1390]|FMH [139000]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CORE [203505]|6050.05||||6050.05|2589.42|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GUARDIAN [1465]|GUARDIAN [146500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA [126008]|6050.05||||6050.05|4392.34|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA PANTEX [126003]|6050.05||||6050.05|2843.52|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|6050.05||||6050.05|2541.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GILSBAR [1425]|GILSBAR [142500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NRECA [1735]|NRECA [173500]|6050.05||||6050.05|3708.68|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6050.05||||6050.05|4392.34|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|<Self-pay>|<Self-pay>|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|6050.05||||6050.05|2117.52|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|6050.05||||6050.05|3708.68|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|6050.05||||6050.05|3085.52|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|6050.05||||6050.05|3448.53|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|6050.05||||6050.05|1170.68|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6050.05||||6050.05|4392.34|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6050.05||||6050.05|3708.68|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TRUSTMARK [2030]|STARMARK [203000]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|6050.05||||6050.05|3025.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|6050.05||||6050.05|696.97|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|6050.05||||6050.05|696.97|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MEDICA [2910]|MEDICA HARMONY [291000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|6050.05||||6050.05|2904.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA TRS [101506]|6050.05||||6050.05|3932.53|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|FREEDOM LIFE [178009]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PHCS [1780]|PHCS MULTIPLAN [178000]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|6050.05||||6050.05|3630.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6050.05||||6050.05|2016.48|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|6050.05||||6050.05|696.97|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|6050.05||||6050.05|3025.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|6050.05||||6050.05|3448.53|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|6050.05||||6050.05|2541.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|6050.05||||6050.05|1875.52|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|TDH BCCS [2341]|TDH BCCS [234100]|6050.05||||6050.05|696.97|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|WEB TPA [2115]|WEB TPA [211501]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|6050.05||||6050.05|4398.39|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHNET [1495]|HEALTHNET [149500]|6050.05||||6050.05|4537.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|6050.05||||6050.05|2589.42|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6050.05||||6050.05|3025.02|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|6050.05||||6050.05|4235.03|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|6050.05||||6050.05|5142.54|5142.54|696.97
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UMR [2035]|UMR CHEROKEE MLR [203504]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6050.05||||6050.05|||
100031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL OMNIFIT EON COCR 132 D 8 42 MM OFFSET L135 MM OD11.3 MM HIP CEMENT CONDYLAR STABILIZE STERILE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|6050.05||||6050.05|||
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]|517.89||||517.89|172.61|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|517.89||||517.89|258.94|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
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>|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|59.66
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 SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|59.66
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 CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|517.89||||517.89|317.47|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|517.89||||517.89|59.66|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|100.21|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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 [100500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDH BCCS [2341]|TDH BCCS [234100]|517.89||||517.89|59.66|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|59.66|440.2|59.66
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 TRS [101506]|517.89||||517.89|336.63|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|517.89||||517.89|160.55|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|59.66
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 PANTEX [126003]|517.89||||517.89|243.41|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|517.89||||517.89|258.94|440.2|59.66
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 CHOICE [203500]|517.89||||517.89|317.47|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|59.66
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 CORE [203505]|517.89||||517.89|221.66|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|59.66
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]|517.89||||517.89|362.52|440.2|59.66
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 OPTIONS [203501]|517.89||||517.89|376.5|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|100.21|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|59.66|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|59.66
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 [211501]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|112.74|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|59.66
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 [126008]|517.89||||517.89|375.99|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|59.66
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [141501]|517.89||||517.89|||
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]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [101514]|517.89||||517.89|||
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 NNJ PRIME HMO [102003]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89|||
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]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [126012]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [214002]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89|||
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 CHEROKEE MLR [203504]|517.89||||517.89|||
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]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|517.89||||517.89|||
100038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L15 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|59.66
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 CHOICE [203500]|517.89||||517.89|317.47|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|100.21|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|59.66
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 CORE [203505]|517.89||||517.89|221.66|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|59.66
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 OPTIONS [203501]|517.89||||517.89|376.5|440.2|59.66
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]|517.89||||517.89|112.74|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|517.89||||517.89|258.94|440.2|59.66
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 PANTEX [126003]|517.89||||517.89|243.41|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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 [211501]|517.89||||517.89|362.52|440.2|59.66
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 CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|517.89||||517.89|258.94|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|59.66
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 [126008]|517.89||||517.89|375.99|440.2|59.66
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]|517.89||||517.89|172.61|440.2|59.66
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]|517.89||||517.89|59.66|440.2|59.66
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 [100500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|100.21|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|517.89||||517.89|59.66|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|59.66
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 TRS [101506]|517.89||||517.89|336.63|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDH BCCS [2341]|TDH BCCS [234100]|517.89||||517.89|59.66|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|517.89||||517.89|160.55|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|59.66
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 SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|517.89||||517.89|317.47|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|59.66|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|59.66
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>|517.89||||517.89|388.42|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|59.66
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [141501]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89|||
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]|517.89||||517.89|||
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 CHEROKEE MLR [203504]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [214002]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [126012]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89|||
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]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89|||
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]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [101514]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89|||
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 NNJ PRIME HMO [102003]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89|||
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]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|||
100039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L20 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|STARMARK [203000]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|100.21|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|59.66|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
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 SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDH BCCS [2341]|TDH BCCS [234100]|517.89||||517.89|59.66|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|59.66
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 TRS [101506]|517.89||||517.89|336.63|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|517.89||||517.89|59.66|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|59.66
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 [100500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|172.61|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|517.89||||517.89|317.47|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|59.66
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>|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|59.66|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|59.66
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 CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|100.21|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|517.89||||517.89|258.94|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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 [211501]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA [1260]|CIGNA [126008]|517.89||||517.89|375.99|440.2|59.66
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 PANTEX [126003]|517.89||||517.89|243.41|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|517.89||||517.89|258.94|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|517.89||||517.89|160.55|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|112.74|440.2|59.66
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 CHOICE [203500]|517.89||||517.89|317.47|440.2|59.66
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UMR [2035]|UMR CORE [203505]|517.89||||517.89|221.66|440.2|59.66
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 OPTIONS [203501]|517.89||||517.89|376.5|440.2|59.66
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]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [141501]|517.89||||517.89|||
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]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89|||
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 NNJ PRIME HMO [102003]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89|||
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]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [101514]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|517.89||||517.89|||
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]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [126012]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89|||
100040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L25 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|||
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 CHEROKEE MLR [203504]|517.89||||517.89|||
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>|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|100.21|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|59.66|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|59.66
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 OPTIONS [203501]|517.89||||517.89|376.5|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|517.89||||517.89|258.94|440.2|59.66
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 [126008]|517.89||||517.89|375.99|440.2|59.66
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 PANTEX [126003]|517.89||||517.89|243.41|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|59.66
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 [211501]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|517.89||||517.89|160.55|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|112.74|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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 [100500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|100.21|440.2|59.66
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 CHOICE [203500]|517.89||||517.89|317.47|440.2|59.66
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 CORE [203505]|517.89||||517.89|221.66|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|59.66
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]|517.89||||517.89|172.61|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|517.89||||517.89|59.66|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|517.89||||517.89|258.94|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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 TRS [101506]|517.89||||517.89|336.63|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDH BCCS [2341]|TDH BCCS [234100]|517.89||||517.89|59.66|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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 CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|517.89||||517.89|317.47|440.2|59.66
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 SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|59.66
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]|517.89||||517.89|59.66|440.2|59.66
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [141501]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89|||
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 CHEROKEE MLR [203504]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [214002]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [126012]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89|||
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]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [101514]|517.89||||517.89|||
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 NNJ PRIME HMO [102003]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89|||
100041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L30 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89|||
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]|517.89||||517.89|||
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]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89|||
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]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
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>|517.89||||517.89|388.42|440.2|59.66
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 CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|59.66
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 SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|517.89||||517.89|59.66|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDH BCCS [2341]|TDH BCCS [234100]|517.89||||517.89|59.66|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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 [100500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|172.61|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|517.89||||517.89|258.94|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|517.89||||517.89|160.55|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|517.89||||517.89|258.94|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|59.66
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 [126008]|517.89||||517.89|375.99|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|59.66|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|517.89||||517.89|317.47|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|100.21|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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 TRS [101506]|517.89||||517.89|336.63|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|112.74|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|59.66
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 CHOICE [203500]|517.89||||517.89|317.47|440.2|59.66
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 OPTIONS [203501]|517.89||||517.89|376.5|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|59.66
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 CORE [203505]|517.89||||517.89|221.66|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|59.66|440.2|59.66
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 PANTEX [126003]|517.89||||517.89|243.41|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|100.21|440.2|59.66
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 [211501]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|59.66
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [101514]|517.89||||517.89|||
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 NNJ PRIME HMO [102003]|517.89||||517.89|||
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]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89|||
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]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89|||
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]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89|||
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 CHEROKEE MLR [203504]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [214002]|517.89||||517.89|||
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]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [126012]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [141501]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|517.89||||517.89|||
100042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L35 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89|||
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>|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBSA [1215]|CBSA [121500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|EQUITABLE [1355]|EQUITABLE INS [135500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|517.89||||517.89|317.47|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|517.89||||517.89|295.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GUARDIAN [1465]|GUARDIAN [146500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|517.89||||517.89|258.94|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|517.89||||517.89|59.66|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TML [1980]|TML [198000]|517.89||||517.89|317.47|440.2|59.66
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 OPTIONS [203501]|517.89||||517.89|376.5|440.2|59.66
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 CORE [203505]|517.89||||517.89|221.66|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|112.74|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FMH BENEFIT SERVICES [1390]|FMH [139000]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|517.89||||517.89|336.63|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|517.89||||517.89|362.52|440.2|59.66
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 PANTEX [126003]|517.89||||517.89|243.41|440.2|59.66
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]|517.89||||517.89|375.99|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|517.89||||517.89|362.52|440.2|59.66
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 [126008]|517.89||||517.89|375.99|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NRECA [1735]|NRECA [173500]|517.89||||517.89|317.47|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|517.89||||517.89|258.94|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|517.89||||517.89|258.94|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|517.89||||517.89|217.51|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|517.89||||517.89|217.51|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDICA [2910]|MEDICA HARMONY [291000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|59.66|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|517.89||||517.89|243.41|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|LEWER AGENCY [1565]|LEWER AGENCY [156500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CORESOURCE [1315]|CORESOURCE [131500]|517.89||||517.89|375.99|440.2|59.66
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 CHOICE [203500]|517.89||||517.89|317.47|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CELTIC LIFE [1220]|CELTIC LIFE [122000]|517.89||||517.89|362.52|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|517.89||||517.89|217.51|440.2|59.66
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 [100500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|517.89||||517.89|100.21|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GROUP HEALTH [2165]|GROUP HEALTH [216500]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|517.89||||517.89|100.21|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|517.89||||517.89|375.99|440.2|59.66
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]|517.89||||517.89|172.61|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|517.89||||517.89|59.66|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|517.89||||517.89|181.26|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|517.89||||517.89|248.59|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|517.89||||517.89|264.12|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|517.89||||517.89|310.73|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|517.89||||517.89|295.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|517.89||||517.89|258.94|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MAILHANDLERS [1595]|MAILHANDLERS [159500]|517.89||||517.89|388.42|440.2|59.66
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]|517.89||||517.89|388.42|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|AETNA [1015]|AMERICAN CONTINENTAL [101507]|517.89||||517.89|388.42|440.2|59.66
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 TRS [101506]|517.89||||517.89|336.63|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|FREEDOM LIFE [178009]|517.89||||517.89|440.2|440.2|59.66
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]|517.89||||517.89|440.2|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PHCS [1780]|PHCS MULTIPLAN [178000]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|517.89||||517.89|160.55|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|517.89||||517.89|440.2|440.2|59.66
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 [211501]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|517.89||||517.89|362.52|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|TDH BCCS [2341]|TDH BCCS [234100]|517.89||||517.89|59.66|440.2|59.66
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 CORE EXCLUSIVE [206022]|517.89||||517.89|221.66|440.2|59.66
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 SHARED SVCS [206010]|517.89||||517.89|376.5|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|517.89||||517.89|317.47|440.2|59.66
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|517.89||||517.89|||
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]|517.89||||517.89|||
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 CHEROKEE MLR [203504]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [214002]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [126012]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [141501]|517.89||||517.89|||
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]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|517.89||||517.89|||
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 MEDICARE SUPPLEMENT [101514]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|CHAMPVA [1240]|CHAMP VA [124000]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|517.89||||517.89|||
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 NNJ PRIME HMO [102003]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|517.89||||517.89|||
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]|CARE IMPROVEMENT PLUS UHC [206002]|517.89||||517.89|||
100043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TORX L40 MM OD6.5 MM ACETABULAR CANCELLOUS TRITANIUM MULTIHOLE SHELL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|517.89||||517.89|||
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]|517.89||||517.89|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.20||||2443.20|1148.31|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.20||||2443.20|1773.77|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2443.20||||2443.20|1497.68|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDH BCCS [2341]|TDH BCCS [234100]|2443.20||||2443.20|281.46|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|FREEDOM LIFE [178009]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA TRS [101506]|2443.20||||2443.20|1588.08|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.20||||2443.20|1465.92|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.20||||2443.20|1246.03|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2443.20||||2443.20|281.46|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.20||||2443.20|1773.77|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.20||||2443.20|281.46|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDICA [2910]|MEDICA HARMONY [291000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.20||||2443.20|814.32|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.20||||2443.20|1026.15|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.20||||2443.20|1026.15|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBSA [1215]|CBSA [121500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GILSBAR [1425]|GILSBAR [142500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2443.20||||2443.20|1221.6|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NRECA [1735]|NRECA [173500]|2443.20||||2443.20|1497.68|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211501]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PANTEX [126003]|2443.20||||2443.20|1148.31|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.20||||2443.20|1588.08|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.20||||2443.20|1221.6|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.20||||2443.20|855.12|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.20||||2443.20|1045.69|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.20||||2443.20|1776.21|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.20||||2443.20|472.76|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.20||||2443.20|1392.63|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.20||||2443.20|1172.74|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.20||||2443.20|531.89|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2443.20||||2443.20|1776.21|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CORE [203505]|2443.20||||2443.20|1045.69|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHOICE [203500]|2443.20||||2443.20|1497.68|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TML [1980]|TML [198000]|2443.20||||2443.20|1497.68|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2443.20||||2443.20|1221.6|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.20||||2443.20|1026.15|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.20||||2443.20|281.46|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.20||||2443.20|1221.6|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.20||||2443.20|472.76|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GUARDIAN [1465]|GUARDIAN [146500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2443.20||||2443.20|757.39|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.20||||2443.20|1710.24|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2443.20||||2443.20|1773.77|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA [126008]|2443.20||||2443.20|1773.77|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.20||||2443.20|1392.63|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.20||||2443.20|2076.72|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.20||||2443.20|1773.77|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.20||||2443.20|1497.68|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2443.20||||2443.20|1832.4|2076.72|281.46
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2443.20||||2443.20|||
100077|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +0MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.20||||2443.20|1392.63|2076.72|281.46
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 [100500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2443.20||||2443.20|1221.6|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2443.20||||2443.20|1832.4|2076.72|281.46
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]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.20||||2443.20|2076.72|2076.72|281.46
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>|2443.20||||2443.20|1832.4|2076.72|281.46
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]|2443.20||||2443.20|1773.77|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBSA [1215]|CBSA [121500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.20||||2443.20|1148.31|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.20||||2443.20|1497.68|2076.72|281.46
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]|2443.20||||2443.20|1773.77|2076.72|281.46
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]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.20||||2443.20|1392.63|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2443.20||||2443.20|1773.77|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.20||||2443.20|472.76|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.20||||2443.20|1221.6|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.20||||2443.20|281.46|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.20||||2443.20|1026.15|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TML [1980]|TML [198000]|2443.20||||2443.20|1497.68|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CORE [203505]|2443.20||||2443.20|1045.69|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHOICE [203500]|2443.20||||2443.20|1497.68|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2443.20||||2443.20|1776.21|2076.72|281.46
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]|2443.20||||2443.20|1832.4|2076.72|281.46
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]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PANTEX [126003]|2443.20||||2443.20|1148.31|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.20||||2443.20|1588.08|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA [126008]|2443.20||||2443.20|1773.77|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.20||||2443.20|1710.24|2076.72|281.46
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]|2443.20||||2443.20|1832.4|2076.72|281.46
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 [211501]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NRECA [1735]|NRECA [173500]|2443.20||||2443.20|1497.68|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2443.20||||2443.20|757.39|2076.72|281.46
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]|2443.20||||2443.20|2076.72|2076.72|281.46
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]|2443.20||||2443.20|531.89|2076.72|281.46
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]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.20||||2443.20|1710.24|2076.72|281.46
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]|2443.20||||2443.20|2076.72|2076.72|281.46
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]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2443.20||||2443.20|1221.6|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.20||||2443.20|1221.6|2076.72|281.46
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]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.20||||2443.20|1026.15|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.20||||2443.20|855.12|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GUARDIAN [1465]|GUARDIAN [146500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.20||||2443.20|1026.15|2076.72|281.46
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]|2443.20||||2443.20|814.32|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDICA [2910]|MEDICA HARMONY [291000]|2443.20||||2443.20|1710.24|2076.72|281.46
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]|2443.20||||2443.20|281.46|2076.72|281.46
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]|2443.20||||2443.20|1832.4|2076.72|281.46
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]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.20||||2443.20|472.76|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.20||||2443.20|1773.77|2076.72|281.46
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]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2443.20||||2443.20|281.46|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.20||||2443.20|1465.92|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.20||||2443.20|1246.03|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.20||||2443.20|1172.74|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.20||||2443.20|1832.4|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA TRS [101506]|2443.20||||2443.20|1588.08|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|FREEDOM LIFE [178009]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.20||||2443.20|1710.24|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2443.20||||2443.20|2076.72|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDH BCCS [2341]|TDH BCCS [234100]|2443.20||||2443.20|281.46|2076.72|281.46
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 CORE EXCLUSIVE [206022]|2443.20||||2443.20|1045.69|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2443.20||||2443.20|1497.68|2076.72|281.46
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 SHARED SVCS [206010]|2443.20||||2443.20|1776.21|2076.72|281.46
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.20||||2443.20|||
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]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.20||||2443.20|||
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]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.20||||2443.20|||
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 MEDICARE SUPPLEMENT [214002]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.20||||2443.20|||
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]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.20||||2443.20|||
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 NNJ PRIME HMO [102003]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.20||||2443.20|||
100078|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.20||||2443.20|1148.31|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBSA [1215]|CBSA [121500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.20||||2443.20|1773.77|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2443.20||||2443.20|1497.68|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.20||||2443.20|1045.69|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.20||||2443.20|1392.63|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2443.20||||2443.20|281.46|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.20||||2443.20|1246.03|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.20||||2443.20|281.46|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.20||||2443.20|814.32|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.20||||2443.20|1026.15|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2443.20||||2443.20|1221.6|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2443.20||||2443.20|757.39|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211501]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NRECA [1735]|NRECA [173500]|2443.20||||2443.20|1497.68|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA [126008]|2443.20||||2443.20|1773.77|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PANTEX [126003]|2443.20||||2443.20|1148.31|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2443.20||||2443.20|1221.6|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.20||||2443.20|1026.15|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.20||||2443.20|1588.08|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.20||||2443.20|855.12|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDICA [2910]|MEDICA HARMONY [291000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.20||||2443.20|472.76|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.20||||2443.20|1773.77|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.20||||2443.20|1172.74|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.20||||2443.20|531.89|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2443.20||||2443.20|1776.21|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CORE [203505]|2443.20||||2443.20|1045.69|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHOICE [203500]|2443.20||||2443.20|1497.68|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TML [1980]|TML [198000]|2443.20||||2443.20|1497.68|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.20||||2443.20|1026.15|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.20||||2443.20|281.46|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA TRS [101506]|2443.20||||2443.20|1588.08|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|FREEDOM LIFE [178009]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.20||||2443.20|1221.6|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.20||||2443.20|472.76|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GUARDIAN [1465]|GUARDIAN [146500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.20||||2443.20|1465.92|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDH BCCS [2341]|TDH BCCS [234100]|2443.20||||2443.20|281.46|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2443.20||||2443.20|1773.77|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.20||||2443.20|1392.63|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.20||||2443.20|2076.72|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.20||||2443.20|1776.21|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.20||||2443.20|1773.77|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.20||||2443.20|1497.68|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.20||||2443.20|1710.24|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GILSBAR [1425]|GILSBAR [142500]|2443.20||||2443.20|1832.4|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.20||||2443.20|1221.6|2076.72|281.46
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.20||||2443.20|||
100079|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL +2.5MM OFFSET C TAPER 28MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBSA [1215]|CBSA [121500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.20||||2443.20|1392.63|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.20||||2443.20|1221.6|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.20||||2443.20|281.46|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CORE [203505]|2443.20||||2443.20|1045.69|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NRECA [1735]|NRECA [173500]|2443.20||||2443.20|1497.68|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2443.20||||2443.20|1221.6|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.20||||2443.20|1026.15|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.20||||2443.20|281.46|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.20||||2443.20|1246.03|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDH BCCS [2341]|TDH BCCS [234100]|2443.20||||2443.20|281.46|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2443.20||||2443.20|1497.68|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.20||||2443.20|1045.69|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.20||||2443.20|1776.21|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|FREEDOM LIFE [178009]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA TRS [101506]|2443.20||||2443.20|1588.08|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.20||||2443.20|1392.63|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.20||||2443.20|1773.77|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.20||||2443.20|472.76|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2443.20||||2443.20|281.46|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.20||||2443.20|814.32|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDICA [2910]|MEDICA HARMONY [291000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.20||||2443.20|1465.92|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.20||||2443.20|1026.15|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.20||||2443.20|855.12|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GILSBAR [1425]|GILSBAR [142500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2443.20||||2443.20|757.39|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.20||||2443.20|1221.6|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211501]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PANTEX [126003]|2443.20||||2443.20|1148.31|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA [126008]|2443.20||||2443.20|1773.77|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.20||||2443.20|1588.08|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2443.20||||2443.20|1221.6|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHOICE [203500]|2443.20||||2443.20|1497.68|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2443.20||||2443.20|1776.21|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TML [1980]|TML [198000]|2443.20||||2443.20|1497.68|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.20||||2443.20|531.89|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.20||||2443.20|1026.15|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.20||||2443.20|1172.74|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.20||||2443.20|472.76|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GUARDIAN [1465]|GUARDIAN [146500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2443.20||||2443.20|1773.77|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.20||||2443.20|1773.77|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.20||||2443.20|1497.68|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.20||||2443.20|2076.72|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.20||||2443.20|1148.31|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.20||||2443.20|1710.24|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.20||||2443.20|1773.77|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.20||||2443.20|1832.4|2076.72|281.46
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.20||||2443.20|||
100084|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -2.5MM OFFSET C TAPER 32MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA [126008]|2443.20||||2443.20|1773.77|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|2443.20||||2443.20|1221.6|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2443.20||||2443.20|1588.08|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|LEWER AGENCY [1565]|LEWER AGENCY [156500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FMH BENEFIT SERVICES [1390]|FMH [139000]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2443.20||||2443.20|531.89|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CORE [203505]|2443.20||||2443.20|1045.69|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHOICE [203500]|2443.20||||2443.20|1497.68|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR OPTIONS [203501]|2443.20||||2443.20|1776.21|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TML [1980]|TML [198000]|2443.20||||2443.20|1497.68|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|2443.20||||2443.20|1026.15|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|2443.20||||2443.20|281.46|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|2443.20||||2443.20|1221.6|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GUARDIAN [1465]|GUARDIAN [146500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CELTIC LIFE [1220]|CELTIC LIFE [122000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA PANTEX [126003]|2443.20||||2443.20|1148.31|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2443.20||||2443.20|1773.77|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|2443.20||||2443.20|1497.68|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|2443.20||||2443.20|1392.63|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CORESOURCE [1315]|CORESOURCE [131500]|2443.20||||2443.20|1773.77|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|2443.20||||2443.20|472.76|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GROUP HEALTH [2165]|GROUP HEALTH [216500]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TRUSTMARK [2030]|STARMARK [203000]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|EQUITABLE [1355]|EQUITABLE INS [135500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|2443.20||||2443.20|1148.31|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBSA [1215]|CBSA [121500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|<Self-pay>|<Self-pay>|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|2443.20||||2443.20|1776.21|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|2443.20||||2443.20|1045.69|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TDH BCCS [2341]|TDH BCCS [234100]|2443.20||||2443.20|281.46|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|PHCS MULTIPLAN [178000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHCS [1780]|FREEDOM LIFE [178009]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AMERICAN CONTINENTAL [101507]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MAILHANDLERS [1595]|MAILHANDLERS [159500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|2443.20||||2443.20|1465.92|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|2443.20||||2443.20|1172.74|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|2443.20||||2443.20|1246.03|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|2443.20||||2443.20|1392.63|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|2443.20||||2443.20|281.46|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2443.20||||2443.20|1773.77|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|2443.20||||2443.20|472.76|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA TRS [101506]|2443.20||||2443.20|1588.08|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|2443.20||||2443.20|281.46|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MEDICA [2910]|MEDICA HARMONY [291000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2443.20||||2443.20|814.32|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|2443.20||||2443.20|1026.15|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|2443.20||||2443.20|855.12|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2443.20||||2443.20|1497.68|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2443.20||||2443.20|1773.77|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|2443.20||||2443.20|1026.15|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GILSBAR [1425]|GILSBAR [142500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2443.20||||2443.20|1221.6|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|2443.20||||2443.20|1221.6|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHNET [1495]|HEALTHNET [149500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|2443.20||||2443.20|2076.72|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|2443.20||||2443.20|757.39|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NRECA [1735]|NRECA [173500]|2443.20||||2443.20|1497.68|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211501]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|WEB TPA [2115]|WEB TPA [211500]|2443.20||||2443.20|1832.4|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|2443.20||||2443.20|1710.24|2076.72|281.46
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UMR [2035]|UMR CHEROKEE MLR [203504]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|CHAMPVA [1240]|CHAMP VA [124000]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2443.20||||2443.20|||
100089|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL -5MM OFFSET C TAPER 36MM HIP HIGH PERFORMANCE BIOLOX DELTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2443.20||||2443.20|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|<Self-pay>|<Self-pay>|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.49||||7.49|5.44|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CBSA [1215]|CBSA [121500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|7.49||||7.49|3.52|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|7.49||||7.49|4.59|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7.49||||7.49|5.44|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|7.49||||7.49|4.27|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CORESOURCE [1315]|CORESOURCE [131500]|7.49||||7.49|5.44|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CELTIC LIFE [1220]|CELTIC LIFE [122000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7.49||||7.49|1.45|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|7.49||||7.49|3.75|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GROUP HEALTH [2165]|GROUP HEALTH [216500]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|7.49||||7.49|0.86|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7.49||||7.49|3.15|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|TML [1980]|TML [198000]|7.49||||7.49|4.59|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UMR [2035]|UMR CORE [203505]|7.49||||7.49|3.21|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UMR [2035]|UMR OPTIONS [203501]|7.49||||7.49|5.45|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UMR [2035]|UMR CHOICE [203500]|7.49||||7.49|4.59|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|LEWER AGENCY [1565]|LEWER AGENCY [156500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.49||||7.49|3.75|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|7.49||||7.49|3.75|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CIGNA [1260]|CIGNA PANTEX [126003]|7.49||||7.49|3.52|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CIGNA [1260]|CIGNA [126008]|7.49||||7.49|5.44|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|WEB TPA [2115]|WEB TPA [211501]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|WEB TPA [2115]|WEB TPA [211500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|NRECA [1735]|NRECA [173500]|7.49||||7.49|4.59|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|7.49||||7.49|2.32|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HEALTHNET [1495]|HEALTHNET [149500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.49||||7.49|1.63|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|7.49||||7.49|3.75|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|7.49||||7.49|3.75|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GILSBAR [1425]|GILSBAR [142500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|7.49||||7.49|3.15|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|7.49||||7.49|2.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|7.49||||7.49|3.15|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.49||||7.49|2.5|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|TRUSTMARK [2030]|STARMARK [203000]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GUARDIAN [1465]|GUARDIAN [146500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MEDICA [2910]|MEDICA HARMONY [291000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7.49||||7.49|0.86|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|7.49||||7.49|1.45|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.49||||7.49|5.44|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7.49||||7.49|0.86|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7.49||||7.49|3.82|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7.49||||7.49|4.27|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7.49||||7.49|4.49|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|7.49||||7.49|3.6|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|EQUITABLE [1355]|EQUITABLE INS [135500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AETNA [1015]|AMERICAN CONTINENTAL [101507]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|7.49||||7.49|5.62|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AETNA [1015]|AETNA TRS [101506]|7.49||||7.49|4.87|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PHCS [1780]|PHCS MULTIPLAN [178000]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PHCS [1780]|FREEDOM LIFE [178009]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|7.49||||7.49|5.24|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|7.49||||7.49|6.37|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|TDH BCCS [2341]|TDH BCCS [234100]|7.49||||7.49|0.86|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|7.49||||7.49|3.21|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.49||||7.49|4.59|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|7.49||||7.49|5.45|6.37|0.86
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UMR [2035]|UMR CHEROKEE MLR [203504]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|CHAMPVA [1240]|CHAMP VA [124000]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.49||||7.49|||
100095|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE SMALL OD2 1/4 IN ODSEC1/2-7/8 IN 2 PIECE MOLDABLE TAN|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|EQUITABLE [1355]|EQUITABLE INS [135500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|7.49||||7.49|3.52|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CBSA [1215]|CBSA [121500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.49||||7.49|5.44|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|<Self-pay>|<Self-pay>|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.49||||7.49|4.59|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|7.49||||7.49|5.45|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|7.49||||7.49|3.21|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|TDH BCCS [2341]|TDH BCCS [234100]|7.49||||7.49|0.86|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PHCS [1780]|PHCS MULTIPLAN [178000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PHCS [1780]|FREEDOM LIFE [178009]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7.49||||7.49|4.49|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7.49||||7.49|4.27|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|7.49||||7.49|3.6|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7.49||||7.49|3.82|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7.49||||7.49|0.86|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.49||||7.49|5.44|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|7.49||||7.49|1.45|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MEDICA [2910]|MEDICA HARMONY [291000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.49||||7.49|2.5|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|7.49||||7.49|3.15|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|7.49||||7.49|2.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|7.49||||7.49|3.15|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GILSBAR [1425]|GILSBAR [142500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|7.49||||7.49|3.75|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HEALTHNET [1495]|HEALTHNET [149500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|7.49||||7.49|2.32|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|7.49||||7.49|3.75|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|NRECA [1735]|NRECA [173500]|7.49||||7.49|4.59|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|WEB TPA [2115]|WEB TPA [211500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|WEB TPA [2115]|WEB TPA [211501]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7.49||||7.49|0.86|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CIGNA [1260]|CIGNA PANTEX [126003]|7.49||||7.49|3.52|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CIGNA [1260]|CIGNA [126008]|7.49||||7.49|5.44|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|7.49||||7.49|3.75|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.49||||7.49|3.75|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|FMH BENEFIT SERVICES [1390]|FMH [139000]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AETNA [1015]|AETNA TRS [101506]|7.49||||7.49|4.87|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.49||||7.49|1.63|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UMR [2035]|UMR CORE [203505]|7.49||||7.49|3.21|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UMR [2035]|UMR OPTIONS [203501]|7.49||||7.49|5.45|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UMR [2035]|UMR CHOICE [203500]|7.49||||7.49|4.59|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|TML [1980]|TML [198000]|7.49||||7.49|4.59|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7.49||||7.49|3.15|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|7.49||||7.49|0.86|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|7.49||||7.49|3.75|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|TRUSTMARK [2030]|STARMARK [203000]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7.49||||7.49|1.45|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GUARDIAN [1465]|GUARDIAN [146500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|7.49||||7.49|5.24|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7.49||||7.49|5.62|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CORESOURCE [1315]|CORESOURCE [131500]|7.49||||7.49|5.44|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|7.49||||7.49|4.27|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7.49||||7.49|6.37|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7.49||||7.49|5.44|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|7.49||||7.49|4.59|6.37|0.86
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CHAMPVA [1240]|CHAMP VA [124000]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UMR [2035]|UMR CHEROKEE MLR [203504]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.49||||7.49|||
100096|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BARRIER SKIN SUR-FIT NATURA DURAHESIVE ACCORDION FLANGE MEDIUM OD2.25 IN ODSEC22-33 IN 2 PIECE TURTLENECK LATEX FREE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|<Self-pay>|<Self-pay>|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.49||||7.49|5.44|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CBSA [1215]|CBSA [121500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|EQUITABLE [1355]|EQUITABLE INS [135500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|7.49||||7.49|4.59|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7.49||||7.49|5.44|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|7.49||||7.49|4.27|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CELTIC LIFE [1220]|CELTIC LIFE [122000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GUARDIAN [1465]|GUARDIAN [146500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|TRUSTMARK [2030]|STARMARK [203000]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|7.49||||7.49|3.75|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GROUP HEALTH [2165]|GROUP HEALTH [216500]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|7.49||||7.49|0.86|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|TML [1980]|TML [198000]|7.49||||7.49|4.59|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UMR [2035]|UMR CORE [203505]|7.49||||7.49|3.21|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UMR [2035]|UMR OPTIONS [203501]|7.49||||7.49|5.45|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.49||||7.49|1.63|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|FMH BENEFIT SERVICES [1390]|FMH [139000]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.49||||7.49|3.75|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CIGNA [1260]|CIGNA PANTEX [126003]|7.49||||7.49|3.52|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CIGNA [1260]|CIGNA [126008]|7.49||||7.49|5.44|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|WEB TPA [2115]|WEB TPA [211500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|WEB TPA [2115]|WEB TPA [211501]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|NRECA [1735]|NRECA [173500]|7.49||||7.49|4.59|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|7.49||||7.49|3.75|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|LEWER AGENCY [1565]|LEWER AGENCY [156500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|7.49||||7.49|2.32|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HEALTHNET [1495]|HEALTHNET [149500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|7.49||||7.49|3.75|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UMR [2035]|UMR CHOICE [203500]|7.49||||7.49|4.59|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|7.49||||7.49|3.75|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GILSBAR [1425]|GILSBAR [142500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|7.49||||7.49|3.15|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|7.49||||7.49|3.15|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|7.49||||7.49|3.15|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|7.49||||7.49|2.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|7.49||||7.49|1.45|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.49||||7.49|2.5|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MEDICA [2910]|MEDICA HARMONY [291000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|7.49||||7.49|0.86|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CORESOURCE [1315]|CORESOURCE [131500]|7.49||||7.49|5.44|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|7.49||||7.49|1.45|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7.49||||7.49|5.44|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|7.49||||7.49|0.86|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|7.49||||7.49|4.27|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|7.49||||7.49|3.82|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|7.49||||7.49|3.6|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|7.49||||7.49|4.49|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|7.49||||7.49|3.52|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MAILHANDLERS [1595]|MAILHANDLERS [159500]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AETNA [1015]|AMERICAN CONTINENTAL [101507]|7.49||||7.49|5.62|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AETNA [1015]|AETNA TRS [101506]|7.49||||7.49|4.87|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PHCS [1780]|FREEDOM LIFE [178009]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PHCS [1780]|PHCS MULTIPLAN [178000]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|7.49||||7.49|5.24|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|7.49||||7.49|6.37|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|TDH BCCS [2341]|TDH BCCS [234100]|7.49||||7.49|0.86|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|7.49||||7.49|3.21|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|7.49||||7.49|5.45|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7.49||||7.49|4.59|6.37|0.86
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UMR [2035]|UMR CHEROKEE MLR [203504]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|CHAMPVA [1240]|CHAMP VA [124000]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.49||||7.49|||
100097|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAFER OSTOMY NATURA SUR-FIT DURAHESIVE MEDIUM OD2.75 IN ODSEC33-45 IN 2 PIECE ACCORDION FLANGE TURTLE NECK LATEX FREE TAN|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|7.49||||7.49|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|EQUITABLE [1355]|EQUITABLE INS [135500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CBSA [1215]|CBSA [121500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.56||||22.56|16.38|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|<Self-pay>|<Self-pay>|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|22.56||||22.56|16.4|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|22.56||||22.56|13.83|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TDH BCCS [2341]|TDH BCCS [234100]|22.56||||22.56|2.6|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PHCS [1780]|PHCS MULTIPLAN [178000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA [1015]|AETNA TRS [101506]|22.56||||22.56|14.67|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|22.56||||22.56|12.86|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|22.56||||22.56|13.54|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|22.56||||22.56|10.83|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.56||||22.56|2.6|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|22.56||||22.56|16.38|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|22.56||||22.56|2.6|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MEDICA [2910]|MEDICA HARMONY [291000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.56||||22.56|7.52|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|22.56||||22.56|9.48|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|22.56||||22.56|9.48|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GILSBAR [1425]|GILSBAR [142500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|22.56||||22.56|11.28|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|22.56||||22.56|11.28|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHNET [1495]|HEALTHNET [149500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|22.56||||22.56|7.9|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|22.56||||22.56|6.99|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|NRECA [1735]|NRECA [173500]|22.56||||22.56|13.83|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|WEB TPA [2115]|WEB TPA [211501]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|WEB TPA [2115]|WEB TPA [211500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CIGNA [1260]|CIGNA [126008]|22.56||||22.56|16.38|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|22.56||||22.56|4.37|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|22.56||||22.56|11.51|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CIGNA [1260]|CIGNA PANTEX [126003]|22.56||||22.56|10.6|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|22.56||||22.56|11.28|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|22.56||||22.56|11.28|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PHCS [1780]|FREEDOM LIFE [178009]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|22.56||||22.56|4.91|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|22.56||||22.56|9.66|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UMR [2035]|UMR CORE [203505]|22.56||||22.56|9.66|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UMR [2035]|UMR OPTIONS [203501]|22.56||||22.56|16.4|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UMR [2035]|UMR CHOICE [203500]|22.56||||22.56|13.83|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TML [1980]|TML [198000]|22.56||||22.56|13.83|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.56||||22.56|9.48|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|22.56||||22.56|2.6|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|22.56||||22.56|10.6|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|22.56||||22.56|11.28|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TRUSTMARK [2030]|STARMARK [203000]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|22.56||||22.56|4.37|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GUARDIAN [1465]|GUARDIAN [146500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|22.56||||22.56|15.79|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.56||||22.56|16.92|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CORESOURCE [1315]|CORESOURCE [131500]|22.56||||22.56|16.38|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|22.56||||22.56|12.86|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.56||||22.56|19.18|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|22.56||||22.56|16.38|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|22.56||||22.56|13.83|19.18|2.6
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CHAMPVA [1240]|CHAMP VA [124000]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UMR [2035]|UMR CHEROKEE MLR [203504]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|22.56||||22.56|||
100098|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PASTE OSTOMY EAKIN COHESIVE 2.1 OZ TUBE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|22.56||||22.56|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|<Self-pay>|<Self-pay>|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CBSA [1215]|CBSA [121500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|495.43||||495.43|232.85|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|EQUITABLE [1355]|EQUITABLE INS [135500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|495.43||||495.43|371.57|421.12|57.07
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]|495.43||||495.43|359.68|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|495.43||||495.43|303.7|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|495.43||||495.43|282.4|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131500]|495.43||||495.43|359.68|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GUARDIAN [1465]|GUARDIAN [146500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|495.43||||495.43|95.87|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|495.43||||495.43|247.72|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TML [1980]|TML [198000]|495.43||||495.43|303.7|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|495.43||||495.43|208.08|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UMR [2035]|UMR CHOICE [203500]|495.43||||495.43|303.7|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UMR [2035]|UMR CORE [203505]|495.43||||495.43|212.04|421.12|57.07
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]|495.43||||495.43|107.86|421.12|57.07
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]|495.43||||495.43|371.57|421.12|57.07
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]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FMH BENEFIT SERVICES [1390]|FMH [139000]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|LEWER AGENCY [1565]|LEWER AGENCY [156500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|495.43||||495.43|247.72|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CIGNA [1260]|CIGNA [126008]|495.43||||495.43|359.68|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CIGNA [1260]|CIGNA PANTEX [126003]|495.43||||495.43|232.85|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GROUP HEALTH [2165]|GROUP HEALTH [216500]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|NRECA [1735]|NRECA [173500]|495.43||||495.43|303.7|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|495.43||||495.43|346.8|421.12|57.07
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]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|WEB TPA [2115]|WEB TPA [211501]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|495.43||||495.43|153.58|421.12|57.07
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]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|495.43||||495.43|247.72|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|495.43||||495.43|421.12|421.12|57.07
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]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|495.43||||495.43|346.8|421.12|57.07
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]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHNET [1495]|HEALTHNET [149500]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|495.43||||495.43|247.72|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|495.43||||495.43|247.72|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UMR [2035]|UMR OPTIONS [203501]|495.43||||495.43|360.18|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GILSBAR [1425]|GILSBAR [142500]|495.43||||495.43|371.57|421.12|57.07
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]|495.43||||495.43|165.13|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|495.43||||495.43|57.07|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TRUSTMARK [2030]|STARMARK [203000]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|495.43||||495.43|208.08|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|495.43||||495.43|208.08|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|495.43||||495.43|173.4|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MEDICA [2910]|MEDICA HARMONY [291000]|495.43||||495.43|346.8|421.12|57.07
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]|495.43||||495.43|57.07|421.12|57.07
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]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CELTIC LIFE [1220]|CELTIC LIFE [122000]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|495.43||||495.43|346.8|421.12|57.07
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]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|495.43||||495.43|95.87|421.12|57.07
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]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|495.43||||495.43|359.68|421.12|57.07
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]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|495.43||||495.43|57.07|421.12|57.07
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]|495.43||||495.43|359.68|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|495.43||||495.43|252.67|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|495.43||||495.43|282.4|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|495.43||||495.43|237.81|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|495.43||||495.43|297.26|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PHCS [1780]|PHCS MULTIPLAN [178000]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PHCS [1780]|FREEDOM LIFE [178009]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MAILHANDLERS [1595]|MAILHANDLERS [159500]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AETNA [1015]|AMERICAN CONTINENTAL [101507]|495.43||||495.43|371.57|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AETNA [1015]|AETNA TRS [101506]|495.43||||495.43|322.03|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|495.43||||495.43|346.8|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|495.43||||495.43|421.12|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|495.43||||495.43|303.7|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|495.43||||495.43|212.04|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|495.43||||495.43|360.18|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|TDH BCCS [2341]|TDH BCCS [234100]|495.43||||495.43|57.07|421.12|57.07
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|495.43||||495.43|||
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]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UMR [2035]|UMR CHEROKEE MLR [203504]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|495.43||||495.43|||
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]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|CHAMPVA [1240]|CHAMP VA [124000]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|495.43||||495.43|||
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]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|495.43||||495.43|||
10010|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSPENSION|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|495.43||||495.43|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|716.86||||716.86|336.92|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CBSA [1215]|CBSA [121500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|<Self-pay>|<Self-pay>|716.86||||716.86|537.65|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|716.86||||716.86|520.44|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|716.86||||716.86|521.16|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|716.86||||716.86|439.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PHCS [1780]|FREEDOM LIFE [178009]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PHCS [1780]|PHCS MULTIPLAN [178000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AETNA [1015]|AMERICAN CONTINENTAL [101507]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|716.86||||716.86|365.6|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|716.86||||716.86|408.61|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|716.86||||716.86|430.12|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|716.86||||716.86|82.58|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|716.86||||716.86|520.44|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|716.86||||716.86|138.71|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MEDICA [2910]|MEDICA HARMONY [291000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|716.86||||716.86|238.93|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|716.86||||716.86|250.9|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|716.86||||716.86|301.08|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|716.86||||716.86|301.08|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GILSBAR [1425]|GILSBAR [142500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|716.86||||716.86|358.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HEALTHNET [1495]|HEALTHNET [149500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|716.86||||716.86|358.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|716.86||||716.86|222.23|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|NRECA [1735]|NRECA [173500]|716.86||||716.86|439.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|WEB TPA [2115]|WEB TPA [211500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|WEB TPA [2115]|WEB TPA [211501]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|716.86||||716.86|82.58|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CIGNA [1260]|CIGNA PANTEX [126003]|716.86||||716.86|336.92|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CIGNA [1260]|CIGNA [126008]|716.86||||716.86|520.44|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|716.86||||716.86|358.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|716.86||||716.86|344.09|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|716.86||||716.86|358.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|LEWER AGENCY [1565]|LEWER AGENCY [156500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|FMH BENEFIT SERVICES [1390]|FMH [139000]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MAILHANDLERS [1595]|MAILHANDLERS [159500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AETNA [1015]|AETNA TRS [101506]|716.86||||716.86|465.96|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|716.86||||716.86|156.06|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UMR [2035]|UMR CORE [203505]|716.86||||716.86|306.82|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|TDH BCCS [2341]|TDH BCCS [234100]|716.86||||716.86|82.58|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|716.86||||716.86|306.82|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UMR [2035]|UMR CHOICE [203500]|716.86||||716.86|439.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UMR [2035]|UMR OPTIONS [203501]|716.86||||716.86|521.16|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|TML [1980]|TML [198000]|716.86||||716.86|439.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|716.86||||716.86|301.08|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|716.86||||716.86|82.58|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|716.86||||716.86|358.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GROUP HEALTH [2165]|GROUP HEALTH [216500]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|TRUSTMARK [2030]|STARMARK [203000]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|716.86||||716.86|138.71|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|EQUITABLE [1355]|EQUITABLE INS [135500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GUARDIAN [1465]|GUARDIAN [146500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CELTIC LIFE [1220]|CELTIC LIFE [122000]|716.86||||716.86|501.8|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|716.86||||716.86|537.64|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CORESOURCE [1315]|CORESOURCE [131500]|716.86||||716.86|520.44|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|716.86||||716.86|609.33|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|716.86||||716.86|408.61|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|716.86||||716.86|520.44|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|716.86||||716.86|439.43|609.33|82.58
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CHAMPVA [1240]|CHAMP VA [124000]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UMR [2035]|UMR CHEROKEE MLR [203504]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|716.86||||716.86|||
100103|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TRAY CATHETER MAHURKAR ELITE POLYURETHANE LARGE L20 CM OD13.5 FR 2 LUMEN HIGH FLOW PASS STRAIGHT EXTENSION GREEN HEMODIALYSIS|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|716.86||||716.86|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1072.23||||1072.23|778.44|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CBSA [1215]|CBSA [121500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1072.23||||1072.23|503.95|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|EQUITABLE [1355]|EQUITABLE INS [135500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1072.23||||1072.23|778.44|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1072.23||||1072.23|611.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CORESOURCE [1315]|CORESOURCE [131500]|1072.23||||1072.23|778.44|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GUARDIAN [1465]|GUARDIAN [146500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|TRUSTMARK [2030]|STARMARK [203000]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1072.23||||1072.23|123.52|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1072.23||||1072.23|450.33|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|TML [1980]|TML [198000]|1072.23||||1072.23|657.27|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UMR [2035]|UMR OPTIONS [203501]|1072.23||||1072.23|779.51|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UMR [2035]|UMR CORE [203505]|1072.23||||1072.23|458.91|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1072.23||||1072.23|233.42|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|FMH BENEFIT SERVICES [1390]|FMH [139000]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1072.23||||1072.23|536.11|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA [126008]|1072.23||||1072.23|778.44|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA PANTEX [126003]|1072.23||||1072.23|503.95|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|WEB TPA [2115]|WEB TPA [211501]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1072.23||||1072.23|536.11|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|WEB TPA [2115]|WEB TPA [211500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|NRECA [1735]|NRECA [173500]|1072.23||||1072.23|657.27|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1072.23||||1072.23|332.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHNET [1495]|HEALTHNET [149500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1072.23||||1072.23|536.11|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UMR [2035]|UMR CHOICE [203500]|1072.23||||1072.23|657.27|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1072.23||||1072.23|536.11|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GILSBAR [1425]|GILSBAR [142500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1072.23||||1072.23|450.33|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1072.23||||1072.23|450.33|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1072.23||||1072.23|375.28|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1072.23||||1072.23|536.11|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1072.23||||1072.23|207.48|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1072.23||||1072.23|357.37|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MEDICA [2910]|MEDICA HARMONY [291000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1072.23||||1072.23|123.52|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1072.23||||1072.23|207.48|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1072.23||||1072.23|778.44|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1072.23||||1072.23|657.27|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1072.23||||1072.23|123.52|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1072.23||||1072.23|514.67|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1072.23||||1072.23|611.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1072.23||||1072.23|643.34|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1072.23||||1072.23|546.83|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA [1015]|AETNA TRS [101506]|1072.23||||1072.23|696.95|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|<Self-pay>|<Self-pay>|1072.23||||1072.23|804.17|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PHCS [1780]|FREEDOM LIFE [178009]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PHCS [1780]|PHCS MULTIPLAN [178000]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1072.23||||1072.23|750.56|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1072.23||||1072.23|911.39|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|TDH BCCS [2341]|TDH BCCS [234100]|1072.23||||1072.23|123.52|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1072.23||||1072.23|779.51|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1072.23||||1072.23|657.27|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1072.23||||1072.23|458.91|911.39|123.52
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UMR [2035]|UMR CHEROKEE MLR [203504]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CHAMPVA [1240]|CHAMP VA [124000]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1072.23||||1072.23|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1072.23||||1072.23|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|EQUITABLE [1355]|EQUITABLE INS [135500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CBSA [1215]|CBSA [121500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3098.59||||3098.59|2249.57|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3098.59||||3098.59|1899.43|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|3098.59||||3098.59|2252.67|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|3098.59||||3098.59|1326.2|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|TDH BCCS [2341]|TDH BCCS [234100]|3098.59||||3098.59|356.96|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PHCS [1780]|FREEDOM LIFE [178009]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA [1015]|AETNA TRS [101506]|3098.59||||3098.59|2014.08|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA [1015]|AMERICAN CONTINENTAL [101507]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MAILHANDLERS [1595]|MAILHANDLERS [159500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|3098.59||||3098.59|1859.15|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|3098.59||||3098.59|1580.28|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|3098.59||||3098.59|1487.32|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|3098.59||||3098.59|356.96|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3098.59||||3098.59|2249.57|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|3098.59||||3098.59|356.96|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MEDICA [2910]|MEDICA HARMONY [291000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3098.59||||3098.59|1032.76|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|3098.59||||3098.59|1301.41|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|3098.59||||3098.59|1301.41|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GILSBAR [1425]|GILSBAR [142500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|3098.59||||3098.59|1549.29|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHNET [1495]|HEALTHNET [149500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|3098.59||||3098.59|1549.29|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|3098.59||||3098.59|1084.51|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|3098.59||||3098.59|960.56|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|NRECA [1735]|NRECA [173500]|3098.59||||3098.59|1899.43|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|WEB TPA [2115]|WEB TPA [211500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|WEB TPA [2115]|WEB TPA [211501]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|3098.59||||3098.59|599.58|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CIGNA [1260]|CIGNA PANTEX [126003]|3098.59||||3098.59|1456.34|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CIGNA [1260]|CIGNA [126008]|3098.59||||3098.59|2249.57|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|3098.59||||3098.59|1549.29|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|3098.59||||3098.59|1766.2|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3098.59||||3098.59|2014.08|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|LEWER AGENCY [1565]|LEWER AGENCY [156500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|FMH BENEFIT SERVICES [1390]|FMH [139000]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PHCS [1780]|PHCS MULTIPLAN [178000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3098.59||||3098.59|674.56|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR [2035]|UMR OPTIONS [203501]|3098.59||||3098.59|2252.67|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR [2035]|UMR CHOICE [203500]|3098.59||||3098.59|1899.43|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR [2035]|UMR CORE [203505]|3098.59||||3098.59|1326.2|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|<Self-pay>|<Self-pay>|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|TML [1980]|TML [198000]|3098.59||||3098.59|1899.43|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|3098.59||||3098.59|1301.41|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|3098.59||||3098.59|356.96|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|3098.59||||3098.59|1456.34|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|3098.59||||3098.59|1549.29|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GROUP HEALTH [2165]|GROUP HEALTH [216500]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|TRUSTMARK [2030]|STARMARK [203000]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|3098.59||||3098.59|599.58|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GUARDIAN [1465]|GUARDIAN [146500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CELTIC LIFE [1220]|CELTIC LIFE [122000]|3098.59||||3098.59|2169.01|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|3098.59||||3098.59|2323.94|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CORESOURCE [1315]|CORESOURCE [131500]|3098.59||||3098.59|2249.57|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|3098.59||||3098.59|2633.8|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|3098.59||||3098.59|1766.2|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|3098.59||||3098.59|2249.57|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|3098.59||||3098.59|1899.43|2633.8|356.96
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CHAMPVA [1240]|CHAMP VA [124000]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR [2035]|UMR CHEROKEE MLR [203504]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3098.59||||3098.59|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|3098.59||||3098.59|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|22.56||||22.56|16.38|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|<Self-pay>|<Self-pay>|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CBSA [1215]|CBSA [121500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|22.56||||22.56|10.6|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|22.56||||22.56|13.83|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|22.56||||22.56|16.38|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CORESOURCE [1315]|CORESOURCE [131500]|22.56||||22.56|16.38|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|22.56||||22.56|4.37|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|TRUSTMARK [2030]|STARMARK [203000]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GROUP HEALTH [2165]|GROUP HEALTH [216500]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|22.56||||22.56|11.28|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|22.56||||22.56|2.6|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|22.56||||22.56|9.48|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|TML [1980]|TML [198000]|22.56||||22.56|13.83|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UMR [2035]|UMR CHOICE [203500]|22.56||||22.56|13.83|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UMR [2035]|UMR OPTIONS [203501]|22.56||||22.56|16.4|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|FMH BENEFIT SERVICES [1390]|FMH [139000]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|LEWER AGENCY [1565]|LEWER AGENCY [156500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|22.56||||22.56|11.28|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|22.56||||22.56|11.28|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA PANTEX [126003]|22.56||||22.56|10.6|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA [126008]|22.56||||22.56|16.38|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|WEB TPA [2115]|WEB TPA [211501]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|WEB TPA [2115]|WEB TPA [211500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|NRECA [1735]|NRECA [173500]|22.56||||22.56|13.83|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|22.56||||22.56|6.99|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHNET [1495]|HEALTHNET [149500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|22.56||||22.56|11.28|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|22.56||||22.56|11.28|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|22.56||||22.56|4.91|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UMR [2035]|UMR CORE [203505]|22.56||||22.56|9.66|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GILSBAR [1425]|GILSBAR [142500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|22.56||||22.56|9.48|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|22.56||||22.56|9.48|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|22.56||||22.56|7.9|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22.56||||22.56|7.52|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GUARDIAN [1465]|GUARDIAN [146500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MEDICA [2910]|MEDICA HARMONY [291000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|22.56||||22.56|2.6|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CELTIC LIFE [1220]|CELTIC LIFE [122000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|22.56||||22.56|4.37|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|22.56||||22.56|12.86|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|22.56||||22.56|16.38|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|22.56||||22.56|2.6|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|22.56||||22.56|13.54|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|22.56||||22.56|11.51|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|22.56||||22.56|10.83|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|22.56||||22.56|12.86|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|EQUITABLE [1355]|EQUITABLE INS [135500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MAILHANDLERS [1595]|MAILHANDLERS [159500]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AETNA [1015]|AETNA TRS [101506]|22.56||||22.56|14.67|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AETNA [1015]|AMERICAN CONTINENTAL [101507]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PHCS [1780]|PHCS MULTIPLAN [178000]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PHCS [1780]|FREEDOM LIFE [178009]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|22.56||||22.56|16.92|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|22.56||||22.56|15.79|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|22.56||||22.56|19.18|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|TDH BCCS [2341]|TDH BCCS [234100]|22.56||||22.56|2.6|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|22.56||||22.56|13.83|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|22.56||||22.56|16.4|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|22.56||||22.56|9.66|19.18|2.6
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UMR [2035]|UMR CHEROKEE MLR [203504]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CHAMPVA [1240]|CHAMP VA [124000]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|22.56||||22.56|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|22.56||||22.56|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR OPTIONS [203501]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PAN AMERICAN LIFE INSURANCE CO [1770]|PAN AMERICAN LIFE [177000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FREEDOM LIFE INSURANCE [1400]|FREEDOM LIFE INSURANCE [140000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHOICE [203500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|POINT COMFORT UNDERWRITERS [2270]|POINT COMFORT UNDERWRITERS [227000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1.44||||1.44|0.31|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TML [1980]|TML [198000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FMH BENEFIT SERVICES [1390]|FMH [139000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMCAR INDUSTRIES [1280]|COMCAR INDUSTRIES [128000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CAPROCK HEALTH PLANS [1200]|CAPROCK HEALTH PLAN [120004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KAISER PERMANENTE [1560]|KAISER PERMANETE OAKLAND CA [156000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDCJ TEXAS DEPARTMENT OF CRIMINAL JUSTICE [1975]|TDCJ TEXAS DEPT OF CRIMINAL JUSTICE [197500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LEWER AGENCY [1565]|LEWER AGENCY [156500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMBINED INSURANCE OF AMERICA [1275]|COMBINED INS OF AMERICA [127500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CHEROKEE MLR [203504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MES SOLUTIONS [1660]|VES SOLUTIONS [166000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP PENSION ADMIN [1450]|GPA IMAGINE HEALTH [145009]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEECH STREET [1170]|BEECH STREET/CAPPCARE MISC [117000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SCOTT & WHITE HEALTH PLAN [2265]|SCOTT & WHITE HEALTH PLAN [226500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|STARMARK [203000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TRUSTMARK [2030]|TRUSTMARK CLINTON IA [203001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PANTEX [126003]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|STAR SUPERIOR MEDICAID [1945]|SUPERIOR CHIP [194501]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GUARDIAN [1465]|GUARDIAN [146500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FEDERATED MUTUAL [1365]|FEDERATED MUTUAL [136500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GROUP HEALTH [2165]|GROUP HEALTH [216500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA MEDICARE SUPPLEMENT [214002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA MEDICARE SUPPLEMENT [126012]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROMINENCE MANAGED MEDICARE [2335]|PROMINENCE MANAGED MEDICARE [233500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|OUHSC-KOMEN [229509]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ONCOLOGY PATIENT ASSISTANCE PROGRAMS [2295]|CPRIT GRANT [229510]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN VETERINARY [1085]|AMERICAN VETERINARY [108500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BENEFIT MANAGEMENT [1175]|BENEFIT MANAGEMENT [117500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NRECA [1735]|NRECA [173500]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NORTHAMERICA ADMINISTRATORS [1725]|NORTHAMERICA ADMINISTRATORS [172500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CELTIC LIFE [1220]|CELTIC LIFE [122000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|WEB TPA [2115]|WEB TPA [211500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE COMMERCIAL [1371]|FIRSTCARE TRS [137106]|1.44||||1.44|0.45|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TEXAS REHABILITATION [1970]|TEXAS WORKFORCE COMMISSION [197000]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NEW ERA LIFE INSURANCE COMPANY [1705]|PHILADELPHIA AMERICAN LIFE [170501]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED NATIONAL GLOBAL CARE [1035]|ALLIED NATIONAL [103500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PLANNED ADMINISTRATORS INC [2360]|PLANNED ADMINISTRATORS INC [236000]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAS CHOICE HEALTH PLANS [1090]|AMERICAS CHOICE HEALTH PLANS [109000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED BEHAVIORAL HEALTH [3820]|UNITED BEHAVIORAL MEDICARE ADVANTAGE [382000]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UCARE MEDICARE REPLACEMENT [2830]|UCARE MEDICARE [283001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY HEALTH CARE [132000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|0.48|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CORE EXCLUSIVE [206022]|1.44||||1.44|0.62|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|0.88|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TDH BCCS [2341]|TDH BCCS [234100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|TOTAL PLAN SERVICES, INC. [2405]|TOTAL PLAN SERVICES, INC. [240502]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE SHARED SVCS [206010]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA TRS [101506]|1.44||||1.44|0.94|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PRINCIPAL MUTUAL LIFE [1845]|PRINCIPAL COLORADO CLAIMS [184500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURERS ADMINISTRATIVE CORP [1550]|INSURERS ADMINISTRATIVE CORP [155000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALIERACARE [2935]|TRINITY HEALTHSHARE [293500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|INTERNATIONAL BENEFITS ADMINISTRATORS [168005]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBA ADMINISTRATORS [1210]|CBA ADMINISTRATORS [121000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|CARE IMPROVEMENT PLUS UHC [206002]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS CLIENT SPECIFIC [154005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHNET [1495]|HEALTHNET [149500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|1.44||||1.44|0.5|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|1.44||||1.44|0.82|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|1.44||||1.44|0.17|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAXOR INSURANCE [1610]|MAXOR INSURANCE [161000]|1.44||||1.44|0.68|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CBSA [1215]|CBSA [121500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RH ADMINISTRATORS [1885]|RH ADMINISTRATORS [188500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|1.44||||1.44|0.73|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESERVE NATIONAL [1880]|RESERVE NATIONAL [188000]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|1.44||||1.44|0.86|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS HEALTHSELECT OF TEXAS [115530]|1.44||||1.44|0.69|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MEDICA [2910]|MEDICA HARMONY [291000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GILSBAR [1425]|GILSBAR [142500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MAILHANDLERS [1595]|MAILHANDLERS [159500]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|FREEDOM LIFE [178009]|1.44||||1.44|1.22|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EQUITABLE [1355]|EQUITABLE INS [135500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PHCS [1780]|PHCS MULTIPLAN [178000]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ASSURANT HEALTH [1105]|ASSURANT HEALTH [110501]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|1.44||||1.44|0.28|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|1.05|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|1.44||||1.44|0.6|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|0.72|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AMERICAN CONTINENTAL [101507]|1.44||||1.44|1.08|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|1.44||||1.44|1.01|1.22|0.17
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST CARE MEDICARE [1370]|FIRSTCARE MEDICARE ADVANTAGE [137000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICAID [1165]|BCBS MEDICAID [116504]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA MEDICARE SUPPLEMENT [141501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA MEDICARE SUPPLEMENT [101514]|1.44||||1.44|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|391.88||||391.88|195.94|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|538.00||||538.00|269|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|730.00||||730.00|84.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|391.88||||391.88|195.94|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|538.00||||538.00|269|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GILSBAR [1425]|GILSBAR [142500]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.88||||391.88|130.61|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|730.00||||730.00|243.31|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.88||||391.88|130.61|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GILSBAR [1425]|GILSBAR [142500]|538.00||||538.00|403.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHEROKEE INSURANCE [1245]|CHEROKEE INSURANCE [124500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|538.00||||538.00|179.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|730.00||||730.00|365|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|391.88||||391.88|164.59|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE SERVICES OF LUBBOCK [1545]|INSURANCE SERVICES OF LUBBOCK [154500]|391.88||||391.88|195.94|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|538.00||||538.00|225.96|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|391.88||||391.88|137.16|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|538.00||||538.00|61.98|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|538.00||||538.00|225.96|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|391.88||||391.88|164.59|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDICA [2910]|MEDICA HARMONY [291000]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|391.88||||391.88|45.14|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDICA [2910]|MEDICA HARMONY [291000]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS BSA EMPLOYEES [154001]|538.00||||538.00|188.3|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|PHCS MULTIPLAN [178000]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDICA [2910]|MEDICA HARMONY [291000]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|391.88||||391.88|45.14|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHOENIX HOME LIFE [1785]|PHOENIX HOME LIFE [178500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|538.00||||538.00|403.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|730.00||||730.00|620.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|730.00||||730.00|529.98|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|538.00||||538.00|390.59|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|730.00||||730.00|141.26|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|730.00||||730.00|620.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|538.00||||538.00|104.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|391.88||||391.88|75.83|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|538.00||||538.00|457.3|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|391.88||||391.88|284.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|538.00||||538.00|457.3|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|730.00||||730.00|547.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391.88||||391.88|333.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MUTUAL OF OMAHA [1685]|MUTUAL OF OMAHA [168500]|391.88||||391.88|333.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDISHARE CHRISTIAN CARE [1645]|MEDISHARE CHRISTIAN CARE [164500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS IN NETWORK [154002]|730.00||||730.00|306.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|730.00||||730.00|547.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|391.88||||391.88|45.14|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|538.00||||538.00|61.98|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|538.00||||538.00|322.8|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|391.88||||391.88|223.37|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|391.88||||391.88|240.22|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GE GROUP ADMINISTRATORS [1405]|GE GROUP ADMINISTRATORS [140500]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PRESBYTERIAN CENTENNIAL CARE [1831]|PRESBYTERIAN CENTENNIAL CARE [183100]|730.00||||730.00|84.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|391.88||||391.88|333.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEDICA [2910]|MEDICA HARMONY [291000]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICAID [3845]|MANAGED MEDICAID OTHER [384500]|391.88||||391.88|45.14|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|730.00||||730.00|416.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|730.00||||730.00|372.3|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|391.88||||391.88|235.13|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED PPO OF TEXAS [115526]|391.88||||391.88|223.37|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS ADVANTAGE HMO OF TEXAS [115525]|391.88||||391.88|199.86|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PBA [1775]|PROFESSIONAL BENEFIT ADMIN [177500]|391.88||||391.88|333.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100500]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|391.88||||391.88|284.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST CARE MEDICAID [1372]|FIRSTCARE CHIP [137202]|391.88||||391.88|75.83|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|INSURANCE MANAGEMENT SERVICES (IMS) [1540]|IMS RANDALL COUNTY [154004]|391.88||||391.88|164.59|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF TEXAS [115503]|730.00||||730.00|438|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|FREEDOM LIFE [178009]|391.88||||391.88|333.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|PHCS MULTIPLAN [178000]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|PHCS MULTIPLAN [178000]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RURAL CARRIER BENEFIT PLAN [1895]|RURAL CARRIER BENEFIT PLAN [189500]|538.00||||538.00|403.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|PHCS MULTIPLAN [178000]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA TRS [101506]|391.88||||391.88|254.72|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAILHANDLERS [1595]|MAILHANDLERS [159500]|538.00||||538.00|403.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAILHANDLERS [1595]|MAILHANDLERS [159500]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MAILHANDLERS [1595]|MAILHANDLERS [159500]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA TRS [101506]|538.00||||538.00|349.7|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|391.88||||391.88|274.32|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|730.00||||730.00|511|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MEGA LIFE AND HEALTH [1650]|MEGA LIFE HEATLH [165001]|538.00||||538.00|376.6|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA TRS [101506]|730.00||||730.00|474.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA TRS [101506]|391.88||||391.88|254.72|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AMERICAN CONTINENTAL [101507]|391.88||||391.88|293.91|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|FREEDOM LIFE [178009]|730.00||||730.00|620.5|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PHCS [1780]|FREEDOM LIFE [178009]|391.88||||391.88|333.1|620.5|45.14
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|538.00||||538.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|538.00||||538.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|JAN WERNER ADULT DAYCARE [1555]|JAN WERNER ADULT DAYCARE [155002]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GOLDEN RULE [1445]|GOLDEN RULE MEDICARE SUPPLEMENT [144500]|538.00||||538.00|||