"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"
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|838.30||||838.30|343.7|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|838.30||||838.30|461.07|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|838.30||||838.30|343.7|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|838.30||||838.30|377.24|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|838.30||||838.30|377.24|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AETNA [1015]|AETNA ACO WILCO [101532]|838.30||||838.30|335.32|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|838.30||||838.30|216.87|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|838.30||||838.30|335.32|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|838.30||||838.30|427.53|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CORESOURCE [1315]|CORESOURCE [131501]|838.30||||838.30|335.32|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|<Self-pay>|<Self-pay>|838.30||||838.30|209.57|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|838.30||||838.30|335.32|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|838.30||||838.30|335.32|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|838.30||||838.30|335.32|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|838.30||||838.30|343.7|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|838.30||||838.30|335.32|461.07|209.57
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS [1155]|TULSA BLUE [115531]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|GEHA [1415]|GEHA - ASA [141503]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|CIGNA [1260]|CIGNA [126008]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|838.30||||838.30|||
100068|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DRILL SURGICAL L110 MM OD3.5 MM OVER SOLID AO CONNECTION|UMR [2035]|UMR CORE [203505]|838.30||||838.30|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|460.65||||460.65|184.26|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CORESOURCE [1315]|CORESOURCE [131501]|460.65||||460.65|184.26|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|460.65||||460.65|184.26|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|460.65||||460.65|188.87|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|460.65||||460.65|234.93|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|<Self-pay>|<Self-pay>|460.65||||460.65|115.16|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|460.65||||460.65|188.87|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|460.65||||460.65|184.26|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|460.65||||460.65|207.29|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|460.65||||460.65|253.36|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|460.65||||460.65|184.26|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AETNA [1015]|AETNA ACO WILCO [101532]|460.65||||460.65|184.26|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|460.65||||460.65|188.87|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|460.65||||460.65|184.26|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|460.65||||460.65|207.29|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|460.65||||460.65|119.17|253.36|115.16
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GEHA [1415]|GEHA - ASA [141503]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|CIGNA [1260]|CIGNA [126008]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UMR [2035]|UMR CORE [203505]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|BCBS [1155]|TULSA BLUE [115531]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|460.65||||460.65|||
100069|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WIRE FIXATION GORILLA OLIVE OD1.4 MM SMOOTH|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|460.65||||460.65|||
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]|726.25||||726.25|187.88|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|726.25||||726.25|326.81|399.44|181.56
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]|726.25||||726.25|290.5|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|726.25||||726.25|326.81|399.44|181.56
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]|726.25||||726.25|370.39|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|726.25||||726.25|297.76|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|726.25||||726.25|297.76|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|726.25||||726.25|290.5|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CORESOURCE [1315]|CORESOURCE [131501]|726.25||||726.25|290.5|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|726.25||||726.25|399.44|399.44|181.56
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]|726.25||||726.25|297.76|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA [1015]|AETNA ACO WILCO [101532]|726.25||||726.25|290.5|399.44|181.56
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]|726.25||||726.25|290.5|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|<Self-pay>|<Self-pay>|726.25||||726.25|181.56|399.44|181.56
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]|726.25||||726.25|290.5|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|726.25||||726.25|290.5|399.44|181.56
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|726.25||||726.25|||
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 CARE IMP PLUS MEDICARE ADV [206508]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UMR [2035]|UMR CORE [203505]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|TULSA BLUE [115531]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|726.25||||726.25|||
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 OKLAHOMA [115501]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA [126008]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GEHA [1415]|GEHA - ASA [141503]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|726.25||||726.25|||
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]|726.25||||726.25|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|726.25||||726.25|||
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]|726.25||||726.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2884.25||||2884.25|1297.91|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2884.25||||2884.25|1105.53|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2884.25||||2884.25|746.16|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2884.25||||2884.25|1105.53|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2884.25||||2884.25|1182.54|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2884.25||||2884.25|1470.97|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA [1015]|AETNA ACO WILCO [101532]|2884.25||||2884.25|1105.53|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|<Self-pay>|<Self-pay>|2884.25||||2884.25|721.06|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2884.25||||2884.25|1182.54|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2884.25||||2884.25|1105.53|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2884.25||||2884.25|1297.91|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2884.25||||2884.25|1182.54|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CORESOURCE [1315]|CORESOURCE [131501]|2884.25||||2884.25|1105.53|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2884.25||||2884.25|1105.53|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2884.25||||2884.25|1586.34|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|2884.25||||2884.25|1297.91|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2884.25||||2884.25|1105.53|1586.34|721.06
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GEHA [1415]|GEHA - ASA [141503]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|TULSA BLUE [115531]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR [2035]|UMR CORE [203505]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CIGNA [1260]|CIGNA [126008]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2884.25||||2884.25|||
100107|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L45 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|2884.25||||2884.25|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|78.00||||78.00|31.2|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|78.00||||78.00|31.2|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|78.00||||78.00|31.98|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AETNA [1015]|AETNA ACO WILCO [101532]|78.00||||78.00|31.2|50.7|19.5
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]|78.00||||78.00|31.2|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|78.00||||78.00|31.98|50.7|19.5
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]|78.00||||78.00|31.98|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|78.00||||78.00|35.1|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|78.00||||78.00|42.9|50.7|19.5
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]|78.00||||78.00|39.78|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA [126008]|78.00||||78.00|50.7|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|<Self-pay>|<Self-pay>|78.00||||78.00|19.5|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|78.00||||78.00|35.1|50.7|19.5
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]|78.00||||78.00|31.2|50.7|19.5
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]|78.00||||78.00|31.2|50.7|19.5
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]|78.00||||78.00|20.18|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CORESOURCE [1315]|CORESOURCE [131501]|78.00||||78.00|31.2|50.7|19.5
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GEHA [1415]|GEHA - ASA [141503]|78.00||||78.00|||
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 [206025]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|78.00||||78.00|||
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 CHARTER [206031]|78.00||||78.00|||
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 CARE IMP PLUS MEDICARE ADV [206508]|78.00||||78.00|||
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 OKLAHOMA [115501]|78.00||||78.00|||
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]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|TULSA BLUE [115531]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|78.00||||78.00|||
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 OF ARKANSAS [115536]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|78.00||||78.00|||
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 OF OKLAHOMA [115500]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|78.00||||78.00|||
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]|78.00||||78.00|||
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]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|78.00||||78.00|||
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]|78.00||||78.00|||
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]|78.00||||78.00|||
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]|78.00||||78.00|||
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]|78.00||||78.00|||
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]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|78.00||||78.00|||
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]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|78.00||||78.00|||
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]|78.00||||78.00|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|78.00||||78.00|||
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 MEDICARE REPLACEMENT [102002]|78.00||||78.00|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|402.29||||402.29|160.92|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|402.29||||402.29|160.92|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|402.29||||402.29|205.17|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|402.29||||402.29|164.94|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|402.29||||402.29|164.94|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|402.29||||402.29|164.94|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|402.29||||402.29|104.07|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|402.29||||402.29|181.03|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|402.29||||402.29|160.92|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|402.29||||402.29|181.03|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|402.29||||402.29|100.57|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|402.29||||402.29|221.26|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CORESOURCE [1315]|CORESOURCE [131501]|402.29||||402.29|160.92|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|402.29||||402.29|160.92|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|402.29||||402.29|160.92|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|402.29||||402.29|160.92|221.26|100.57
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UMR CORE [203505]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA [126008]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|TULSA BLUE [115531]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA - ASA [141503]|402.29||||402.29|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|402.29||||402.29|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|92.40||||92.40|23.9|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|92.40||||92.40|37.89|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|92.40||||92.40|47.13|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|<Self-pay>|<Self-pay>|92.40||||92.40|23.1|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|92.40||||92.40|37.89|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|92.40||||92.40|36.96|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|92.40||||92.40|41.58|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|92.40||||92.40|36.96|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|92.40||||92.40|36.96|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|CORESOURCE [1315]|CORESOURCE [131501]|92.40||||92.40|36.96|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|AETNA [1015]|AETNA ACO WILCO [101532]|92.40||||92.40|36.96|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|92.40||||92.40|36.96|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|92.40||||92.40|50.82|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|92.40||||92.40|37.89|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|92.40||||92.40|36.96|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|92.40||||92.40|41.58|50.82|23.1
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|BCBS [1155]|TULSA BLUE [115531]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UMR [2035]|UMR CORE [203505]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|CIGNA [1260]|CIGNA [126008]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|GEHA [1415]|GEHA - ASA [141503]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|92.40||||92.40|||
100265|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE CLOSURE STRATAFIX PDS PLUS 2-0 CT-1 L18 IN ABSORBABLE KNOTLESS TISSUE CONTROL SYMMETRIC VIOLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|92.40||||92.40|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|617.50||||617.50|314.93|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|617.50||||617.50|277.88|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|617.50||||617.50|277.88|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|<Self-pay>|<Self-pay>|617.50||||617.50|154.37|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|617.50||||617.50|253.18|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|617.50||||617.50|159.75|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|617.50||||617.50|253.18|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|617.50||||617.50|339.63|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|617.50||||617.50|253.18|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|617.50||||617.50|277.88|339.63|154.37
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UMR [2035]|UMR CORE [203505]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|GEHA [1415]|GEHA - ASA [141503]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CORESOURCE [1315]|CORESOURCE [131501]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|CIGNA [1260]|CIGNA [126008]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|TULSA BLUE [115531]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|617.50||||617.50|||
100271|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE REUNION L24 MM OD6.5 MM CENTER STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|617.50||||617.50|253.18|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|<Self-pay>|<Self-pay>|617.50||||617.50|154.37|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|617.50||||617.50|314.93|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|617.50||||617.50|277.88|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|617.50||||617.50|159.75|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|617.50||||617.50|253.18|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|617.50||||617.50|277.88|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|617.50||||617.50|253.18|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|617.50||||617.50|339.63|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|617.50||||617.50|277.88|339.63|154.37
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|TULSA BLUE [115531]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA [1015]|AETNA ACO WILCO [101532]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UMR [2035]|UMR CORE [203505]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CIGNA [1260]|CIGNA [126008]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CORESOURCE [1315]|CORESOURCE [131501]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GEHA [1415]|GEHA - ASA [141503]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|617.50||||617.50|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|617.50||||617.50|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4829.56||||4829.56|1851.17|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|<Self-pay>|<Self-pay>|4829.56||||4829.56|1207.39|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|4829.56||||4829.56|1980.12|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|4829.56||||4829.56|2173.3|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4829.56||||4829.56|1851.17|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4829.56||||4829.56|1851.17|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4829.56||||4829.56|2463.08|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4829.56||||4829.56|1851.17|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|4829.56||||4829.56|1851.17|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4829.56||||4829.56|1851.17|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|4829.56||||4829.56|2173.3|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CORESOURCE [1315]|CORESOURCE [131501]|4829.56||||4829.56|1851.17|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|4829.56||||4829.56|1980.12|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|4829.56||||4829.56|1980.12|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|4829.56||||4829.56|2656.26|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4829.56||||4829.56|1249.41|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|4829.56||||4829.56|2173.3|2656.26|1207.39
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GEHA [1415]|GEHA - ASA [141503]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UMR [2035]|UMR CORE [203505]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|TULSA BLUE [115531]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CIGNA [1260]|CIGNA [126008]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|4829.56||||4829.56|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|4829.56||||4829.56|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3942.50||||3942.50|1019.92|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3942.50||||3942.50|1511.16|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3942.50||||3942.50|1511.16|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|<Self-pay>|<Self-pay>|3942.50||||3942.50|985.62|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3942.50||||3942.50|1616.43|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3942.50||||3942.50|1616.43|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3942.50||||3942.50|1774.13|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|3942.50||||3942.50|1511.16|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3942.50||||3942.50|2010.68|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CORESOURCE [1315]|CORESOURCE [131501]|3942.50||||3942.50|1511.16|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3942.50||||3942.50|1774.13|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3942.50||||3942.50|1511.16|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3942.50||||3942.50|1774.13|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3942.50||||3942.50|1511.16|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3942.50||||3942.50|2168.38|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3942.50||||3942.50|1616.43|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3942.50||||3942.50|1511.16|2168.38|985.62
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|TULSA BLUE [115531]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CIGNA [1260]|CIGNA [126008]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UMR [2035]|UMR CORE [203505]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GEHA [1415]|GEHA - ASA [141503]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3942.50||||3942.50|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3942.50||||3942.50|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|158.19||||158.19|87|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|158.19||||158.19|71.18|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|158.19||||158.19|64.86|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|158.19||||158.19|71.18|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.19||||158.19|40.92|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|158.19||||158.19|80.68|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|158.19||||158.19|64.86|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|158.19||||158.19|39.55|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|158.19||||158.19|64.86|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|158.19||||158.19|71.18|87|39.55
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UMR CORE [203505]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA [126008]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|158.19||||158.19|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|158.19||||158.19|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.75||||14.75|3.82|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|14.75||||14.75|6.05|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|14.75||||14.75|6.05|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|14.75||||14.75|3.69|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|14.75||||14.75|7.52|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|14.75||||14.75|6.05|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|14.75||||14.75|6.05|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|14.75||||14.75|3.69|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|14.75||||14.75|6.64|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|14.75||||14.75|7.52|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|14.75||||14.75|6.64|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|14.75||||14.75|6.64|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|14.75||||14.75|8.11|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|14.75||||14.75|6.05|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.75||||14.75|3.82|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|14.75||||14.75|8.11|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|14.75||||14.75|6.05|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|14.75||||14.75|6.64|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|14.75||||14.75|5.9|8.11|3.69
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|14.75||||14.75|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.75||||14.75|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|158.19||||158.19|87|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|158.19||||158.19|71.18|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|158.19||||158.19|71.18|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|158.19||||158.19|64.86|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|158.19||||158.19|39.55|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|158.19||||158.19|64.86|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|158.19||||158.19|64.86|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.19||||158.19|40.92|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|158.19||||158.19|71.18|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|158.19||||158.19|80.68|87|39.55
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UMR CORE [203505]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA [126008]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|158.19||||158.19|||
10040|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L40 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|7.05|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|<Self-pay>|<Self-pay>|17.63||||17.63|4.41|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|8.99|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|158.19||||158.19|39.55|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|158.19||||158.19|64.86|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|158.19||||158.19|71.18|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|7.23|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|7.05|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|7.05|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|158.19||||158.19|71.18|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|7.05|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|158.19||||158.19|87|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|7.05|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|158.19||||158.19|80.68|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|7.05|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|158.19||||158.19|71.18|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|4.56|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|7.23|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.19||||158.19|40.92|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|158.19||||158.19|64.86|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|158.19||||158.19|64.86|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|7.23|87|4.41
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|7.05|87|4.41
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UMR CORE [203505]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA [126008]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|158.19||||158.19|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.19||||158.19|||
10042|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 150 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63|||
10042|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L50 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|158.19||||158.19|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|7.23|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|7.23|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|<Self-pay>|<Self-pay>|17.63||||17.63|4.41|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|8.99|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|<Self-pay>|<Self-pay>|17.63||||17.63|4.41|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|7.23|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|7.23|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|7.23|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|4.56|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|7.05|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|4.56|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|7.23|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|8.99|9.7|4.41
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63|||
10043|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 50 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|4.56|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|7.23|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|7.23|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|7.23|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|<Self-pay>|<Self-pay>|17.63||||17.63|4.41|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|8.99|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|7.23|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|7.23|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|8.99|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|<Self-pay>|<Self-pay>|17.63||||17.63|4.41|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|7.23|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|4.56|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|7.05|9.7|4.41
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.63||||17.63|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|159.38||||159.38|71.72|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|159.38||||159.38|71.72|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|159.38||||159.38|65.34|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|159.38||||159.38|87.66|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|159.38||||159.38|81.28|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|159.38||||159.38|39.85|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|159.38||||159.38|65.34|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|159.38||||159.38|65.34|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|159.38||||159.38|41.23|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|159.38||||159.38|71.72|87.66|39.85
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA - ASA [141503]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CORESOURCE [1315]|CORESOURCE [131501]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UMR CORE [203505]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|TULSA BLUE [115531]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA [126008]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|159.38||||159.38|||
10045|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L14 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|159.38||||159.38|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|24149.02||||24149.02|10867.06|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|24149.02||||24149.02|6247.35|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|24149.02||||24149.02|9256.32|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|24149.02||||24149.02|9901.1|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|24149.02||||24149.02|9256.32|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|24149.02||||24149.02|12316|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|<Self-pay>|<Self-pay>|24149.02||||24149.02|6037.26|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|24149.02||||24149.02|9256.32|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|24149.02||||24149.02|9901.1|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|24149.02||||24149.02|9901.1|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|24149.02||||24149.02|9256.32|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|CORESOURCE [1315]|CORESOURCE [131501]|24149.02||||24149.02|9256.32|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|24149.02||||24149.02|10867.06|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|24149.02||||24149.02|9256.32|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|24149.02||||24149.02|13281.96|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|24149.02||||24149.02|10867.06|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|24149.02||||24149.02|9256.32|13281.96|6037.26
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|CIGNA [1260]|CIGNA [126008]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|BCBS [1155]|TULSA BLUE [115531]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UMR [2035]|UMR CORE [203505]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|GEHA [1415]|GEHA - ASA [141503]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|24149.02||||24149.02|||
100535|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 7 KNEE LEFT TOTAL STABILIZE STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|24149.02||||24149.02|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|17.63||||17.63|9.7|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|17.63||||17.63|7.93|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|7.23|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|17.63||||17.63|7.23|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|<Self-pay>|<Self-pay>|17.63||||17.63|4.41|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|8.99|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|<Self-pay>|<Self-pay>|17.63||||17.63|4.41|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|17.63||||17.63|7.93|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|7.23|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|7.23|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|17.63||||17.63|7.23|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|4.56|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|17.63||||17.63|7.05|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|17.63||||17.63|4.56|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|17.63||||17.63|7.23|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|17.63||||17.63|8.99|9.7|4.41
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR [2035]|UMR CORE [203505]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA [1260]|CIGNA [126008]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|17.63||||17.63|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|17.63||||17.63|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1729.00||||1729.00|778.05|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1729.00||||1729.00|447.29|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1729.00||||1729.00|708.89|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1729.00||||1729.00|662.73|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1729.00||||1729.00|662.73|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1729.00||||1729.00|881.79|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|<Self-pay>|<Self-pay>|1729.00||||1729.00|432.25|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|1729.00||||1729.00|662.73|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1729.00||||1729.00|708.89|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1729.00||||1729.00|662.73|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|CORESOURCE [1315]|CORESOURCE [131501]|1729.00||||1729.00|662.73|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1729.00||||1729.00|778.05|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1729.00||||1729.00|662.73|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1729.00||||1729.00|950.95|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1729.00||||1729.00|778.05|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1729.00||||1729.00|708.89|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1729.00||||1729.00|662.73|950.95|432.25
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|TULSA BLUE [115531]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UMR [2035]|UMR CORE [203505]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|CIGNA [1260]|CIGNA [126008]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1729.00||||1729.00|||
100600|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +4 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1729.00||||1729.00|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|CORESOURCE [1315]|CORESOURCE [131501]|124.80||||124.80|49.92|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|124.80||||124.80|49.92|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|124.80||||124.80|56.16|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|124.80||||124.80|51.17|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|124.80||||124.80|68.64|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|124.80||||124.80|63.65|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|<Self-pay>|<Self-pay>|124.80||||124.80|31.2|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|124.80||||124.80|49.92|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|124.80||||124.80|49.92|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|124.80||||124.80|51.17|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|124.80||||124.80|49.92|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|AETNA [1015]|AETNA ACO WILCO [101532]|124.80||||124.80|49.92|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|124.80||||124.80|51.17|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|124.80||||124.80|32.29|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|124.80||||124.80|56.16|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|124.80||||124.80|49.92|68.64|31.2
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|GEHA [1415]|GEHA - ASA [141503]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UMR [2035]|UMR CORE [203505]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|BCBS [1155]|TULSA BLUE [115531]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|CIGNA [1260]|CIGNA [126008]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|124.80||||124.80|||
100671|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TIP COLONOSCOPE ENDOCUFF VISION ADULT LARGE ID11.2 MM 1 ROW FLEXIBLE ARM FLATTEN FOLD DRY GRIP STERILE LATEX FREE DISPOSABLE GREEN|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|124.80||||124.80|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1729.00||||1729.00|447.29|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1729.00||||1729.00|778.05|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1729.00||||1729.00|708.89|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1729.00||||1729.00|662.73|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1729.00||||1729.00|662.73|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|<Self-pay>|<Self-pay>|1729.00||||1729.00|432.25|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1729.00||||1729.00|881.79|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1729.00||||1729.00|708.89|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AETNA [1015]|AETNA ACO WILCO [101532]|1729.00||||1729.00|662.73|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1729.00||||1729.00|778.05|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1729.00||||1729.00|708.89|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1729.00||||1729.00|662.73|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|CORESOURCE [1315]|CORESOURCE [131501]|1729.00||||1729.00|662.73|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1729.00||||1729.00|778.05|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1729.00||||1729.00|662.73|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1729.00||||1729.00|950.95|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1729.00||||1729.00|662.73|950.95|432.25
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|TULSA BLUE [115531]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|CIGNA [1260]|CIGNA [126008]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UMR [2035]|UMR CORE [203505]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|GEHA [1415]|GEHA - ASA [141503]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1729.00||||1729.00|||
100849|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD FEMORAL V40 LFIT COCR +0 MM OFFSET TAPER OD28 MM HIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1729.00||||1729.00|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|6204.25||||6204.25|2791.91|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CORESOURCE [1315]|CORESOURCE [131501]|6204.25||||6204.25|2378.09|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6204.25||||6204.25|2378.09|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6204.25||||6204.25|2791.91|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6204.25||||6204.25|2543.74|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6204.25||||6204.25|3412.34|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|<Self-pay>|<Self-pay>|6204.25||||6204.25|1551.06|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6204.25||||6204.25|2543.74|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6204.25||||6204.25|2791.91|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6204.25||||6204.25|2378.09|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6204.25||||6204.25|2378.09|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6204.25||||6204.25|1605.04|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6204.25||||6204.25|2543.74|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6204.25||||6204.25|2378.09|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AETNA [1015]|AETNA ACO WILCO [101532]|6204.25||||6204.25|2378.09|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6204.25||||6204.25|3164.17|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6204.25||||6204.25|2378.09|3412.34|1551.06
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GEHA [1415]|GEHA - ASA [141503]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UMR [2035]|UMR CORE [203505]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|TULSA BLUE [115531]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6204.25||||6204.25|||
100889|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SYSTEM FIXATION TIGHTROPE XP TITANIUM SYNDESMOSIS|CIGNA [1260]|CIGNA [126008]|6204.25||||6204.25|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
101|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 325 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|CORESOURCE [1315]|CORESOURCE [131501]|3693.50||||3693.50|1415.72|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3693.50||||3693.50|1662.08|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3693.50||||3693.50|1415.72|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3693.50||||3693.50|1514.34|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3693.50||||3693.50|2031.43|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3693.50||||3693.50|1662.08|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|<Self-pay>|<Self-pay>|3693.50||||3693.50|923.37|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3693.50||||3693.50|1415.72|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|AETNA [1015]|AETNA ACO WILCO [101532]|3693.50||||3693.50|1415.72|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3693.50||||3693.50|955.51|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3693.50||||3693.50|1415.72|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3693.50||||3693.50|1415.72|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3693.50||||3693.50|1662.08|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3693.50||||3693.50|1514.34|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3693.50||||3693.50|1514.34|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3693.50||||3693.50|1415.72|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3693.50||||3693.50|1883.69|2031.43|923.37
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|GEHA [1415]|GEHA - ASA [141503]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UMR [2035]|UMR CORE [203505]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|BCBS [1155]|TULSA BLUE [115531]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|CIGNA [1260]|CIGNA [126008]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3693.50||||3693.50|||
101001|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 4 UNIVERSAL KNEE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3693.50||||3693.50|1662.08|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3693.50||||3693.50|1415.72|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|3693.50||||3693.50|1415.72|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|<Self-pay>|<Self-pay>|3693.50||||3693.50|923.37|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3693.50||||3693.50|1883.69|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3693.50||||3693.50|1514.34|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3693.50||||3693.50|1662.08|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3693.50||||3693.50|1415.72|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3693.50||||3693.50|955.51|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3693.50||||3693.50|1415.72|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3693.50||||3693.50|1662.08|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|3693.50||||3693.50|1415.72|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3693.50||||3693.50|1415.72|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3693.50||||3693.50|2031.43|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3693.50||||3693.50|1514.34|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3693.50||||3693.50|1514.34|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3693.50||||3693.50|1415.72|2031.43|923.37
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UMR [2035]|UMR CORE [203505]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|CIGNA [1260]|CIGNA [126008]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3693.50||||3693.50|||
101004|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL TRIATHLON COCR 7 UNIVERSAL KNEE STERILE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3693.50||||3693.50|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|CORESOURCE [1315]|CORESOURCE [131501]|13309.05||||13309.05|5101.36|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|13309.05||||13309.05|5101.36|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|13309.05||||13309.05|5456.71|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|13309.05||||13309.05|7319.98|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|13309.05||||13309.05|5989.07|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13309.05||||13309.05|3443.05|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|13309.05||||13309.05|6787.62|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|AETNA [1015]|AETNA ACO WILCO [101532]|13309.05||||13309.05|5101.36|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|13309.05||||13309.05|5101.36|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13309.05||||13309.05|5101.36|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|13309.05||||13309.05|5101.36|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13309.05||||13309.05|5101.36|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|13309.05||||13309.05|5456.71|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|13309.05||||13309.05|5456.71|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|13309.05||||13309.05|5989.07|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|<Self-pay>|<Self-pay>|13309.05||||13309.05|3327.26|7319.98|3327.26
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|GEHA [1415]|GEHA - ASA [141503]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UMR [2035]|UMR CORE [203505]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|BCBS [1155]|TULSA BLUE [115531]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|CIGNA [1260]|CIGNA [126008]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|13309.05||||13309.05|||
101014|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BONE FLUID BIOBURST 1.0ML|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|13309.05||||13309.05|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1742.00||||1742.00|783.9|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1742.00||||1742.00|667.71|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|AETNA [1015]|AETNA ACO WILCO [101532]|1742.00||||1742.00|667.71|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|<Self-pay>|<Self-pay>|1742.00||||1742.00|435.5|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1742.00||||1742.00|888.42|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1742.00||||1742.00|714.22|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1742.00||||1742.00|783.9|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1742.00||||1742.00|667.71|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1742.00||||1742.00|450.66|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1742.00||||1742.00|667.71|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1742.00||||1742.00|783.9|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|CORESOURCE [1315]|CORESOURCE [131501]|1742.00||||1742.00|667.71|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1742.00||||1742.00|667.71|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1742.00||||1742.00|958.1|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1742.00||||1742.00|714.22|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1742.00||||1742.00|714.22|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1742.00||||1742.00|667.71|958.1|435.5
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|BCBS [1155]|TULSA BLUE [115531]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UMR [2035]|UMR CORE [203505]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|CIGNA [1260]|CIGNA [126008]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|GEHA [1415]|GEHA - ASA [141503]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1742.00||||1742.00|||
101034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD 45MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1742.00||||1742.00|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|68.28||||68.28|27.31|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|68.28||||68.28|27.31|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|68.28||||68.28|30.72|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|68.28||||68.28|27.99|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|68.28||||68.28|37.55|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|68.28||||68.28|34.82|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|<Self-pay>|<Self-pay>|68.28||||68.28|17.07|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|68.28||||68.28|27.31|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|68.28||||68.28|27.31|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|68.28||||68.28|27.31|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|68.28||||68.28|27.31|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|68.28||||68.28|27.99|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|68.28||||68.28|27.99|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|68.28||||68.28|17.66|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|68.28||||68.28|30.72|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|68.28||||68.28|27.31|37.55|17.07
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UMR [2035]|UMR CORE [203505]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|CIGNA [1260]|CIGNA [126008]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|68.28||||68.28|||
101162|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX ULTRA 360 30 D BEVEL L4 IN OD20 GA INSULATE ECHOGENIC EXTENSION SET STERILE LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|68.28||||68.28|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|<Self-pay>|<Self-pay>|12.86||||12.86|3.21|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.86||||12.86|6.56|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.86||||12.86|5.79|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.86||||12.86|5.79|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.86||||12.86|5.27|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.86||||12.86|5.14|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|12.86||||12.86|5.14|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.86||||12.86|5.14|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.86||||12.86|5.14|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.86||||12.86|7.07|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.86||||12.86|5.14|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.86||||12.86|3.33|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.86||||12.86|5.27|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.86||||12.86|5.27|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.86||||12.86|5.14|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|12.86||||12.86|5.14|7.07|3.21
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UMR [2035]|UMR CORE [203505]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|CIGNA [1260]|CIGNA [126008]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.86||||12.86|||
10117|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|GLIPIZIDE 5 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.86||||12.86|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3735.00||||3735.00|1431.63|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3735.00||||3735.00|1680.75|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|3735.00||||3735.00|1431.63|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3735.00||||3735.00|1431.63|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3735.00||||3735.00|1531.35|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3735.00||||3735.00|1680.75|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3735.00||||3735.00|1904.85|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3735.00||||3735.00|1431.63|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|<Self-pay>|<Self-pay>|3735.00||||3735.00|933.75|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|3735.00||||3735.00|1431.63|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3735.00||||3735.00|2054.25|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3735.00||||3735.00|1431.63|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3735.00||||3735.00|1431.63|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3735.00||||3735.00|1531.35|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3735.00||||3735.00|1531.35|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3735.00||||3735.00|966.24|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3735.00||||3735.00|1680.75|2054.25|933.75
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UMR [2035]|UMR CORE [203505]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|CIGNA [1260]|CIGNA [126008]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3735.00||||3735.00|||
101170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 6.5MM 50MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3735.00||||3735.00|1680.75|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3735.00||||3735.00|966.24|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3735.00||||3735.00|1531.35|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3735.00||||3735.00|1431.63|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|<Self-pay>|<Self-pay>|3735.00||||3735.00|933.75|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3735.00||||3735.00|1431.63|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3735.00||||3735.00|1904.85|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|3735.00||||3735.00|1431.63|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3735.00||||3735.00|1680.75|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3735.00||||3735.00|1531.35|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3735.00||||3735.00|1531.35|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3735.00||||3735.00|1431.63|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|3735.00||||3735.00|1431.63|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3735.00||||3735.00|1680.75|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3735.00||||3735.00|1431.63|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3735.00||||3735.00|2054.25|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3735.00||||3735.00|1431.63|2054.25|933.75
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|CIGNA [1260]|CIGNA [126008]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UMR [2035]|UMR CORE [203505]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3735.00||||3735.00|||
101174|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 8.5MM 55MM RELINE-O 2S SPINE POLYAXIAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3735.00||||3735.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|390.00||||390.00|175.5|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|390.00||||390.00|159.9|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|390.00||||390.00|175.5|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|390.00||||390.00|198.9|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|<Self-pay>|<Self-pay>|390.00||||390.00|97.5|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|390.00||||390.00|214.5|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|390.00||||390.00|159.9|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|390.00||||390.00|159.9|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390.00||||390.00|100.89|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|390.00||||390.00|175.5|214.5|97.5
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UMR [2035]|UMR CORE [203505]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|CIGNA [1260]|CIGNA [126008]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|390.00||||390.00|||
101178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE 5.5MM RELINE SPINE LOCK OPEN TULIP NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|390.00||||390.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1040.00||||1040.00|468|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1040.00||||1040.00|269.05|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1040.00||||1040.00|426.4|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|<Self-pay>|<Self-pay>|1040.00||||1040.00|260|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1040.00||||1040.00|530.4|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1040.00||||1040.00|468|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1040.00||||1040.00|426.4|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1040.00||||1040.00|426.4|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1040.00||||1040.00|572|572|260
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|CIGNA [1260]|CIGNA [126008]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UMR [2035]|UMR CORE [203505]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1040.00||||1040.00|||
101179|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL RELINE TITANIUM LORDOTIC L110 MM OD5.5 MM NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1040.00||||1040.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|390.00||||390.00|175.5|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|390.00||||390.00|159.9|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|390.00||||390.00|175.5|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|390.00||||390.00|198.9|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|<Self-pay>|<Self-pay>|390.00||||390.00|97.5|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|390.00||||390.00|214.5|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|390.00||||390.00|159.9|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|390.00||||390.00|159.9|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390.00||||390.00|100.89|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|390.00||||390.00|175.5|214.5|97.5
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|GEHA [1415]|GEHA - ASA [141503]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|CORESOURCE [1315]|CORESOURCE [131501]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UMR [2035]|UMR CORE [203505]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|AETNA [1015]|AETNA ACO WILCO [101532]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|BCBS [1155]|TULSA BLUE [115531]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|CIGNA [1260]|CIGNA [126008]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|390.00||||390.00|||
101181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X65MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|390.00||||390.00|175.5|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|390.00||||390.00|100.89|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|390.00||||390.00|159.9|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|390.00||||390.00|159.9|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|<Self-pay>|<Self-pay>|390.00||||390.00|97.5|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|390.00||||390.00|198.9|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|390.00||||390.00|175.5|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|390.00||||390.00|159.9|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|390.00||||390.00|175.5|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|390.00||||390.00|214.5|214.5|97.5
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|CIGNA [1260]|CIGNA [126008]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UMR [2035]|UMR CORE [203505]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|AETNA [1015]|AETNA ACO WILCO [101532]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|BCBS [1155]|TULSA BLUE [115531]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|CORESOURCE [1315]|CORESOURCE [131501]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|GEHA [1415]|GEHA - ASA [141503]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|390.00||||390.00|||
101182|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD PREBENT 5.5X70MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|390.00||||390.00|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|929.60||||929.60|371.84|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|CORESOURCE [1315]|CORESOURCE [131501]|929.60||||929.60|371.84|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|929.60||||929.60|371.84|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|929.60||||929.60|381.14|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|929.60||||929.60|418.32|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|929.60||||929.60|474.1|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|<Self-pay>|<Self-pay>|929.60||||929.60|232.4|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|929.60||||929.60|371.84|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AETNA [1015]|AETNA ACO WILCO [101532]|929.60||||929.60|371.84|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|929.60||||929.60|511.28|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|929.60||||929.60|371.84|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|929.60||||929.60|371.84|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|929.60||||929.60|381.14|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|929.60||||929.60|381.14|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|929.60||||929.60|240.49|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|929.60||||929.60|418.32|511.28|232.4
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GEHA [1415]|GEHA - ASA [141503]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UMR [2035]|UMR CORE [203505]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|TULSA BLUE [115531]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|CIGNA [1260]|CIGNA [126008]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|929.60||||929.60|||
101243|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL L125 MM L100 MM OD2 MM AO QUICK CONNECT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|929.60||||929.60|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5602.50||||5602.50|2521.13|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5602.50||||5602.50|1449.37|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5602.50||||5602.50|2297.03|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5602.50||||5602.50|2297.03|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5602.50||||5602.50|2147.44|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5602.50||||5602.50|2147.44|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|<Self-pay>|<Self-pay>|5602.50||||5602.50|1400.62|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5602.50||||5602.50|2857.28|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|AETNA [1015]|AETNA ACO WILCO [101532]|5602.50||||5602.50|2147.44|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5602.50||||5602.50|2521.13|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5602.50||||5602.50|2297.03|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5602.50||||5602.50|2147.44|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|CORESOURCE [1315]|CORESOURCE [131501]|5602.50||||5602.50|2147.44|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5602.50||||5602.50|2521.13|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5602.50||||5602.50|2147.44|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5602.50||||5602.50|3081.38|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5602.50||||5602.50|2147.44|3081.38|1400.62
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|CIGNA [1260]|CIGNA [126008]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UMR [2035]|UMR CORE [203505]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|BCBS [1155]|TULSA BLUE [115531]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|GEHA [1415]|GEHA - ASA [141503]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5602.50||||5602.50|||
101261|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LVL 28MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5602.50||||5602.50|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6640.00||||6640.00|2545.11|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|6640.00||||6640.00|2988|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|CORESOURCE [1315]|CORESOURCE [131501]|6640.00||||6640.00|2545.11|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6640.00||||6640.00|2545.11|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6640.00||||6640.00|2722.4|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6640.00||||6640.00|2988|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6640.00||||6640.00|3386.4|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|<Self-pay>|<Self-pay>|6640.00||||6640.00|1660|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6640.00||||6640.00|2545.11|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|AETNA [1015]|AETNA ACO WILCO [101532]|6640.00||||6640.00|2545.11|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6640.00||||6640.00|3652|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6640.00||||6640.00|2545.11|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6640.00||||6640.00|2545.11|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6640.00||||6640.00|2722.4|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6640.00||||6640.00|2722.4|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6640.00||||6640.00|1717.77|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6640.00||||6640.00|2988|3652|1660
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|GEHA [1415]|GEHA - ASA [141503]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UMR [2035]|UMR CORE [203505]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|BCBS [1155]|TULSA BLUE [115531]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|CIGNA [1260]|CIGNA [126008]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6640.00||||6640.00|||
101262|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3 LVL 42MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6640.00||||6640.00|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2697.50||||2697.50|1213.88|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2697.50||||2697.50|697.84|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2697.50||||2697.50|1105.98|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2697.50||||2697.50|1033.95|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|<Self-pay>|<Self-pay>|2697.50||||2697.50|674.37|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2697.50||||2697.50|1033.95|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2697.50||||2697.50|1375.73|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|2697.50||||2697.50|1033.95|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2697.50||||2697.50|1213.88|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2697.50||||2697.50|1105.98|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2697.50||||2697.50|1105.98|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2697.50||||2697.50|1033.95|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|2697.50||||2697.50|1033.95|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|2697.50||||2697.50|1213.88|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2697.50||||2697.50|1033.95|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2697.50||||2697.50|1483.63|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2697.50||||2697.50|1033.95|1483.63|674.37
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|CIGNA [1260]|CIGNA [126008]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UMR [2035]|UMR CORE [203505]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|2697.50||||2697.50|||
101318|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ELLIPSE TITANIUM L30 MM OD4 MM SPINE POLYAXIAL NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2697.50||||2697.50|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|32.31||||32.31|12.93|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|CORESOURCE [1315]|CORESOURCE [131501]|32.31||||32.31|12.93|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|32.31||||32.31|12.93|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|32.31||||32.31|13.25|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|32.31||||32.31|14.54|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|32.31||||32.31|16.48|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|32.31||||32.31|12.93|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|<Self-pay>|<Self-pay>|32.31||||32.31|8.08|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|AETNA [1015]|AETNA ACO WILCO [101532]|32.31||||32.31|12.93|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|32.31||||32.31|17.77|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|32.31||||32.31|12.93|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|32.31||||32.31|12.93|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|32.31||||32.31|13.25|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|32.31||||32.31|13.25|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|32.31||||32.31|8.36|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|32.31||||32.31|14.54|17.77|8.08
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|GEHA [1415]|GEHA - ASA [141503]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UMR [2035]|UMR CORE [203505]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|BCBS [1155]|TULSA BLUE [115531]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|CIGNA [1260]|CIGNA [126008]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|32.31||||32.31|||
101337|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING 1 LIMB CONVENTIONAL NON HEAT 72IN ADULT 22MM NIV CAPNOMETER|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|32.31||||32.31|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5.88||||5.88|2.64|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5.88||||5.88|1.52|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5.88||||5.88|2.41|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5.88||||5.88|2.41|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5.88||||5.88|2.35|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5.88||||5.88|2.35|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|<Self-pay>|<Self-pay>|5.88||||5.88|1.47|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5.88||||5.88|3|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|5.88||||5.88|2.35|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5.88||||5.88|2.64|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5.88||||5.88|2.41|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5.88||||5.88|2.35|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|5.88||||5.88|2.35|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5.88||||5.88|2.35|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5.88||||5.88|3.23|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5.88||||5.88|2.35|3.23|1.47
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|CIGNA [1260]|CIGNA [126008]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UMR [2035]|UMR CORE [203505]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5.88||||5.88|||
101340|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CANNULA NASAL 7FT OVER THE EAR STAR LUMEN TUBING STANDARD CONNECTOR PEDIATRIC SOFTECH NONSTERILE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5.88||||5.88|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3.31||||3.31|1.33|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|CORESOURCE [1315]|CORESOURCE [131501]|3.31||||3.31|1.33|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3.31||||3.31|1.33|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3.31||||3.31|1.36|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3.31||||3.31|1.49|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3.31||||3.31|1.69|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|<Self-pay>|<Self-pay>|3.31||||3.31|0.83|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3.31||||3.31|1.33|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AETNA [1015]|AETNA ACO WILCO [101532]|3.31||||3.31|1.33|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3.31||||3.31|1.82|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3.31||||3.31|1.33|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3.31||||3.31|1.33|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3.31||||3.31|1.36|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3.31||||3.31|1.36|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3.31||||3.31|0.86|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3.31||||3.31|1.49|1.82|0.83
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GEHA [1415]|GEHA - ASA [141503]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UMR [2035]|UMR CORE [203505]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|TULSA BLUE [115531]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|CIGNA [1260]|CIGNA [126008]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3.31||||3.31|||
101358|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|TUBING OXYGEN 14FT CONNECTOR VINYL STAR LUMEN STANDARD LATEX FREE GREEN TINT|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3.31||||3.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.31||||12.31|5.54|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.31||||12.31|3.19|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.31||||12.31|5.05|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.31||||12.31|5.05|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.31||||12.31|4.93|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.31||||12.31|4.93|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|<Self-pay>|<Self-pay>|12.31||||12.31|3.08|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.31||||12.31|6.28|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|12.31||||12.31|4.93|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.31||||12.31|5.54|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.31||||12.31|5.05|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.31||||12.31|4.93|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|12.31||||12.31|4.93|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.31||||12.31|4.93|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.31||||12.31|6.77|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.31||||12.31|4.93|6.77|3.08
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|CIGNA [1260]|CIGNA [126008]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UMR [2035]|UMR CORE [203505]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.31||||12.31|||
101361|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CIRCUIT BREATHING HUDSON RCI ADULT STANDARD L72 IN OD22 MM 2 INSPIRATORY LIMB STRAIGHT CONNECTOR CONVENTIONAL PORTE WYE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.31||||12.31|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.40||||75.40|30.16|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|75.40||||75.40|30.16|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|75.40||||75.40|30.16|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|75.40||||75.40|30.91|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|75.40||||75.40|33.93|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|75.40||||75.40|38.45|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|<Self-pay>|<Self-pay>|75.40||||75.40|18.85|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.40||||75.40|30.16|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|75.40||||75.40|30.16|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|75.40||||75.40|41.47|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|75.40||||75.40|30.16|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|75.40||||75.40|30.16|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|75.40||||75.40|30.91|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|75.40||||75.40|30.91|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.40||||75.40|19.51|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|75.40||||75.40|33.93|41.47|18.85
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UMR [2035]|UMR CORE [203505]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|CIGNA [1260]|CIGNA [126008]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|75.40||||75.40|||
101371|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX CORNERSTONE NANOLINE L3 1/4 IN OD22 GA ECHOGENIC FACET TIP STIMULATE INJECTION TUBE LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|75.40||||75.40|33.93|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|75.40||||75.40|19.51|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|75.40||||75.40|30.91|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|75.40||||75.40|30.91|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|75.40||||75.40|30.16|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|75.40||||75.40|30.16|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|<Self-pay>|<Self-pay>|75.40||||75.40|18.85|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|75.40||||75.40|30.16|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|75.40||||75.40|38.45|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|75.40||||75.40|33.93|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|75.40||||75.40|30.91|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|75.40||||75.40|30.16|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|CORESOURCE [1315]|CORESOURCE [131501]|75.40||||75.40|30.16|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|75.40||||75.40|30.16|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|75.40||||75.40|41.47|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|75.40||||75.40|30.16|41.47|18.85
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA [126008]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|TULSA BLUE [115531]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UMR CORE [203505]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA - ASA [141503]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|75.40||||75.40|||
101372|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE BLOCK SONOPLEX II L50 MM OD22 GA FACET TIP INJECTION TUBE CONNECT CABLE STERILE LATEX FREE DISPOSABLE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|75.40||||75.40|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|6640.00||||6640.00|2545.11|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|6640.00||||6640.00|2988|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|CORESOURCE [1315]|CORESOURCE [131501]|6640.00||||6640.00|2545.11|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|6640.00||||6640.00|2545.11|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|6640.00||||6640.00|2722.4|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|6640.00||||6640.00|2988|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|6640.00||||6640.00|3386.4|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|<Self-pay>|<Self-pay>|6640.00||||6640.00|1660|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|6640.00||||6640.00|2545.11|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|AETNA [1015]|AETNA ACO WILCO [101532]|6640.00||||6640.00|2545.11|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|6640.00||||6640.00|3652|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6640.00||||6640.00|2545.11|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6640.00||||6640.00|2545.11|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|6640.00||||6640.00|2722.4|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|6640.00||||6640.00|2722.4|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6640.00||||6640.00|1717.77|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|6640.00||||6640.00|2988|3652|1660
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|GEHA [1415]|GEHA - ASA [141503]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UMR [2035]|UMR CORE [203505]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|BCBS [1155]|TULSA BLUE [115531]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|CIGNA [1260]|CIGNA [126008]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|6640.00||||6640.00|||
101374|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 3-LEVEL 54MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|6640.00||||6640.00|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7677.50||||7677.50|3454.88|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7677.50||||7677.50|1986.17|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7677.50||||7677.50|3147.78|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7677.50||||7677.50|3147.78|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7677.50||||7677.50|2942.79|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7677.50||||7677.50|2942.79|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|<Self-pay>|<Self-pay>|7677.50||||7677.50|1919.37|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7677.50||||7677.50|3915.53|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|AETNA [1015]|AETNA ACO WILCO [101532]|7677.50||||7677.50|2942.79|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7677.50||||7677.50|3454.88|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7677.50||||7677.50|3147.78|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7677.50||||7677.50|2942.79|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|CORESOURCE [1315]|CORESOURCE [131501]|7677.50||||7677.50|2942.79|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7677.50||||7677.50|3454.88|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7677.50||||7677.50|2942.79|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7677.50||||7677.50|4222.63|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7677.50||||7677.50|2942.79|4222.63|1919.37
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|CIGNA [1260]|CIGNA [126008]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|BCBS [1155]|TULSA BLUE [115531]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UMR [2035]|UMR CORE [203505]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|GEHA [1415]|GEHA - ASA [141503]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7677.50||||7677.50|||
101375|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 4-LEVEL 64MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7677.50||||7677.50|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|156.25||||156.25|70.31|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|156.25||||156.25|64.06|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|156.25||||156.25|70.31|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|156.25||||156.25|79.69|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|<Self-pay>|<Self-pay>|156.25||||156.25|39.06|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|156.25||||156.25|85.94|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|156.25||||156.25|64.06|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|156.25||||156.25|64.06|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|156.25||||156.25|40.42|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|156.25||||156.25|70.31|85.94|39.06
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|GEHA [1415]|GEHA - ASA [141503]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|CORESOURCE [1315]|CORESOURCE [131501]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UMR [2035]|UMR CORE [203505]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|AETNA [1015]|AETNA ACO WILCO [101532]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|BCBS [1155]|TULSA BLUE [115531]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|CIGNA [1260]|CIGNA [126008]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|156.25||||156.25|||
101376|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW SELF DRILL 4.0 X 12MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|156.25||||156.25|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3112.50||||3112.50|1400.63|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3112.50||||3112.50|805.2|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3112.50||||3112.50|1276.13|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3112.50||||3112.50|1276.13|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3112.50||||3112.50|1193.02|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3112.50||||3112.50|1193.02|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|<Self-pay>|<Self-pay>|3112.50||||3112.50|778.12|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3112.50||||3112.50|1587.38|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|AETNA [1015]|AETNA ACO WILCO [101532]|3112.50||||3112.50|1193.02|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3112.50||||3112.50|1400.63|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3112.50||||3112.50|1276.13|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3112.50||||3112.50|1193.02|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|CORESOURCE [1315]|CORESOURCE [131501]|3112.50||||3112.50|1193.02|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3112.50||||3112.50|1400.63|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3112.50||||3112.50|1193.02|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3112.50||||3112.50|1711.88|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3112.50||||3112.50|1193.02|1711.88|778.12
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|CIGNA [1260]|CIGNA [126008]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|BCBS [1155]|TULSA BLUE [115531]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UMR [2035]|UMR CORE [203505]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|GEHA [1415]|GEHA - ASA [141503]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3112.50||||3112.50|||
101378|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 6MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3112.50||||3112.50|1193.02|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3112.50||||3112.50|1400.63|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|CORESOURCE [1315]|CORESOURCE [131501]|3112.50||||3112.50|1193.02|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3112.50||||3112.50|1193.02|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3112.50||||3112.50|1276.13|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3112.50||||3112.50|1400.63|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3112.50||||3112.50|1587.38|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|<Self-pay>|<Self-pay>|3112.50||||3112.50|778.12|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3112.50||||3112.50|1193.02|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AETNA [1015]|AETNA ACO WILCO [101532]|3112.50||||3112.50|1193.02|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3112.50||||3112.50|1711.88|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3112.50||||3112.50|1193.02|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3112.50||||3112.50|1193.02|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3112.50||||3112.50|1276.13|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3112.50||||3112.50|1276.13|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3112.50||||3112.50|805.2|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3112.50||||3112.50|1400.63|1711.88|778.12
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GEHA [1415]|GEHA - ASA [141503]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UMR [2035]|UMR CORE [203505]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|TULSA BLUE [115531]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|CIGNA [1260]|CIGNA [126008]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3112.50||||3112.50|||
101379|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3112.50||||3112.50|1400.63|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3112.50||||3112.50|805.2|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3112.50||||3112.50|1276.13|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3112.50||||3112.50|1276.13|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3112.50||||3112.50|1193.02|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3112.50||||3112.50|1193.02|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|<Self-pay>|<Self-pay>|3112.50||||3112.50|778.12|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3112.50||||3112.50|1587.38|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AETNA [1015]|AETNA ACO WILCO [101532]|3112.50||||3112.50|1193.02|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3112.50||||3112.50|1400.63|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3112.50||||3112.50|1276.13|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3112.50||||3112.50|1193.02|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|CORESOURCE [1315]|CORESOURCE [131501]|3112.50||||3112.50|1193.02|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3112.50||||3112.50|1400.63|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3112.50||||3112.50|1193.02|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3112.50||||3112.50|1711.88|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3112.50||||3112.50|1193.02|1711.88|778.12
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|CIGNA [1260]|CIGNA [126008]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|TULSA BLUE [115531]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UMR [2035]|UMR CORE [203505]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|GEHA [1415]|GEHA - ASA [141503]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3112.50||||3112.50|||
101380|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CAGE CERVICAL LORDITIC 7MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3112.50||||3112.50|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|57.30||||57.30|22.92|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|CORESOURCE [1315]|CORESOURCE [131501]|57.30||||57.30|22.92|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|57.30||||57.30|22.92|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|57.30||||57.30|23.49|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|57.30||||57.30|25.79|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|57.30||||57.30|29.23|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|<Self-pay>|<Self-pay>|57.30||||57.30|14.32|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|57.30||||57.30|22.92|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AETNA [1015]|AETNA ACO WILCO [101532]|57.30||||57.30|22.92|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|57.30||||57.30|31.52|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|57.30||||57.30|22.92|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|57.30||||57.30|22.92|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|57.30||||57.30|23.49|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|57.30||||57.30|23.49|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|57.30||||57.30|14.82|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|57.30||||57.30|25.79|31.52|14.32
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GEHA [1415]|GEHA - ASA [141503]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UMR [2035]|UMR CORE [203505]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|BCBS [1155]|TULSA BLUE [115531]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|CIGNA [1260]|CIGNA [126008]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|57.30||||57.30|||
101453|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|SUTURE ABSORBABLE VICRYL 8-0 TG140-8 L12 IN 2 ARM BRAID COATED VIOLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|57.30||||57.30|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|4362.48||||4362.48|1963.12|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4362.48||||4362.48|1128.57|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|4362.48||||4362.48|1788.62|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|4362.48||||4362.48|1788.62|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4362.48||||4362.48|1672.14|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|4362.48||||4362.48|1672.14|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|<Self-pay>|<Self-pay>|4362.48||||4362.48|1090.62|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|4362.48||||4362.48|2224.86|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|AETNA [1015]|AETNA ACO WILCO [101532]|4362.48||||4362.48|1672.14|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|4362.48||||4362.48|1963.12|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|4362.48||||4362.48|1788.62|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|4362.48||||4362.48|1672.14|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|CORESOURCE [1315]|CORESOURCE [131501]|4362.48||||4362.48|1672.14|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|4362.48||||4362.48|1963.12|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|4362.48||||4362.48|1672.14|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|4362.48||||4362.48|2399.36|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4362.48||||4362.48|1672.14|2399.36|1090.62
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|CIGNA [1260]|CIGNA [126008]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|BCBS [1155]|TULSA BLUE [115531]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UMR [2035]|UMR CORE [203505]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|GEHA [1415]|GEHA - ASA [141503]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|4362.48||||4362.48|||
101593|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT FEMORAL 10MM TRIATHLON 7 KNEE POSTERIOR TOTAL STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|4362.48||||4362.48|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|34.76|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|34.76|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|34.76|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|34.76|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90|2.9|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|35.63|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|44.32|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|<Self-pay>|<Self-pay>|86.90||||86.90|21.72|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|34.76|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|34.76|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|34.76|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|35.63|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|35.63|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|22.48|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90|2.9|47.8|2.9
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90|||
10176|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|153.80||||153.80|2.9|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|153.80||||153.80|2.9|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|153.80||||153.80|2.9|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153.80||||153.80|39.79|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153.80||||153.80|39.79|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|<Self-pay>|<Self-pay>|153.80||||153.80|38.45|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|<Self-pay>|<Self-pay>|153.80||||153.80|38.45|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|<Self-pay>|<Self-pay>|153.80||||153.80|38.45|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|153.80||||153.80|78.44|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|153.80||||153.80|78.44|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|153.80||||153.80|78.44|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|153.80||||153.80|69.21|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|153.80||||153.80|69.21|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|153.80||||153.80|69.21|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|153.80||||153.80|2.9|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|153.80||||153.80|2.9|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|153.80||||153.80|2.9|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|153.80||||153.80|69.21|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|153.80||||153.80|69.21|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|153.80||||153.80|69.21|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|153.80||||153.80|63.06|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|153.80||||153.80|39.79|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|153.80||||153.80|84.59|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|153.80||||153.80|84.59|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|153.80||||153.80|84.59|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|153.80||||153.80|61.52|84.59|2.9
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153.80||||153.80|||
10177|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|153.80||||153.80|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.90||||86.90|34.76|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.90||||86.90|34.76|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.90||||86.90|34.76|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.90||||86.90|34.76|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.90||||86.90|1.45|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.90||||86.90|39.11|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.90||||86.90|35.63|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.90||||86.90|39.11|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.90||||86.90|44.32|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|<Self-pay>|<Self-pay>|86.90||||86.90|21.72|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.90||||86.90|34.76|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.90||||86.90|34.76|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.90||||86.90|47.8|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.90||||86.90|34.76|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.90||||86.90|35.63|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.90||||86.90|35.63|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.90||||86.90|22.48|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.90||||86.90|1.45|47.8|1.45
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.90||||86.90|||
10181|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.90||||86.90|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|88.40||||88.40|39.78|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|88.40||||88.40|22.87|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|88.40||||88.40|36.24|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|88.40||||88.40|36.24|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|88.40||||88.40|35.36|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|88.40||||88.40|35.36|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|<Self-pay>|<Self-pay>|88.40||||88.40|22.1|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|88.40||||88.40|45.08|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|AETNA [1015]|AETNA ACO WILCO [101532]|88.40||||88.40|35.36|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|88.40||||88.40|39.78|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|88.40||||88.40|36.24|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|88.40||||88.40|35.36|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|CORESOURCE [1315]|CORESOURCE [131501]|88.40||||88.40|35.36|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|88.40||||88.40|35.36|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|88.40||||88.40|48.62|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|88.40||||88.40|35.36|48.62|22.1
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|CIGNA [1260]|CIGNA [126008]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|BCBS [1155]|TULSA BLUE [115531]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UMR [2035]|UMR CORE [203505]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|GEHA [1415]|GEHA - ASA [141503]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|88.40||||88.40|||
101952|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|PACK SURGICAL ENT TULSA SPINE SPECIALTY HOSPITAL|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|88.40||||88.40|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|7.71||||7.71|4.24|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|7.71||||7.71|3.47|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|7.71||||7.71|3.16|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|7.71||||7.71|3.47|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|7.71||||7.71|3.93|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|<Self-pay>|<Self-pay>|7.71||||7.71|1.93|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7.71||||7.71|3.08|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|7.71||||7.71|3.16|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|7.71||||7.71|3.16|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7.71||||7.71|1.99|4.24|1.93
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UMR [2035]|UMR CORE [203505]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|CIGNA [1260]|CIGNA [126008]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
102|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 500 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|7.71||||7.71|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|49.38||||49.38|22.22|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|49.38||||49.38|20.24|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|49.38||||49.38|19.75|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|AETNA [1015]|AETNA ACO WILCO [101532]|49.38||||49.38|19.75|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|<Self-pay>|<Self-pay>|49.38||||49.38|12.35|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|49.38||||49.38|25.18|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|49.38||||49.38|22.22|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|49.38||||49.38|19.75|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|49.38||||49.38|20.24|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|49.38||||49.38|12.77|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|49.38||||49.38|20.24|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|49.38||||49.38|19.75|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|CORESOURCE [1315]|CORESOURCE [131501]|49.38||||49.38|19.75|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|49.38||||49.38|19.75|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|49.38||||49.38|27.16|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|49.38||||49.38|19.75|27.16|12.35
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|CIGNA [1260]|CIGNA [126008]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|BCBS [1155]|TULSA BLUE [115531]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UMR [2035]|UMR CORE [203505]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|GEHA [1415]|GEHA - ASA [141503]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|49.38||||49.38|||
102012|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CAUTERY DISP LOW TEMP FINE TIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|49.38||||49.38|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1846.00||||1846.00|707.57|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1846.00||||1846.00|830.7|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|1846.00||||1846.00|707.57|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1846.00||||1846.00|707.57|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1846.00||||1846.00|756.86|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1846.00||||1846.00|830.7|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1846.00||||1846.00|477.56|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1846.00||||1846.00|941.46|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|<Self-pay>|<Self-pay>|1846.00||||1846.00|461.5|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1846.00||||1846.00|707.57|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|1846.00||||1846.00|707.57|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1846.00||||1846.00|1015.3|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1846.00||||1846.00|707.57|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1846.00||||1846.00|707.57|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1846.00||||1846.00|756.86|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1846.00||||1846.00|756.86|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1846.00||||1846.00|830.7|1015.3|461.5
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UMR [2035]|UMR CORE [203505]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|CIGNA [1260]|CIGNA [126008]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1846.00||||1846.00|||
102015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE FIREBIRD L40 MM OD4.5 MM SPINE SELF TAP MODULAR NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1846.00||||1846.00|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|956.80||||956.80|430.56|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|956.80||||956.80|392.29|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|<Self-pay>|<Self-pay>|956.80||||956.80|239.2|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|956.80||||956.80|487.97|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|956.80||||956.80|430.56|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|956.80||||956.80|392.29|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|956.80||||956.80|247.52|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|956.80||||956.80|392.29|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|956.80||||956.80|526.24|526.24|239.2
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|CIGNA [1260]|CIGNA [126008]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UMR [2035]|UMR CORE [203505]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|BCBS [1155]|TULSA BLUE [115531]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|CORESOURCE [1315]|CORESOURCE [131501]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|GEHA [1415]|GEHA - ASA [141503]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|956.80||||956.80|||
102016|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|ROD SPINAL FIREBIRD TITANIUM STRAIGHT L450 MM OD5.5 MM ANODIZE NONSTERILE POSTERIOR THORACOLUMBAR SYSTEM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|956.80||||956.80|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|2282.50||||2282.50|874.88|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|2282.50||||2282.50|1027.13|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|CORESOURCE [1315]|CORESOURCE [131501]|2282.50||||2282.50|874.88|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|2282.50||||2282.50|874.88|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|2282.50||||2282.50|935.83|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|2282.50||||2282.50|1027.13|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2282.50||||2282.50|590.48|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|2282.50||||2282.50|1164.08|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|<Self-pay>|<Self-pay>|2282.50||||2282.50|570.62|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|2282.50||||2282.50|874.88|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|AETNA [1015]|AETNA ACO WILCO [101532]|2282.50||||2282.50|874.88|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|2282.50||||2282.50|1255.38|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2282.50||||2282.50|874.88|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2282.50||||2282.50|874.88|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|2282.50||||2282.50|935.83|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|2282.50||||2282.50|935.83|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|2282.50||||2282.50|1027.13|1255.38|570.62
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|GEHA [1415]|GEHA - ASA [141503]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UMR [2035]|UMR CORE [203505]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|BCBS [1155]|TULSA BLUE [115531]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|CIGNA [1260]|CIGNA [126008]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|2282.50||||2282.50|||
102017|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW POLY SINGLE 7.5X45MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|2282.50||||2282.50|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|78.13||||78.13|35.16|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|78.13||||78.13|32.03|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|<Self-pay>|<Self-pay>|78.13||||78.13|19.54|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|78.13||||78.13|39.84|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|78.13||||78.13|35.16|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|78.13||||78.13|32.03|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|78.13||||78.13|20.21|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|78.13||||78.13|32.03|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|78.13||||78.13|35.16|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|78.13||||78.13|42.97|42.97|19.54
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|CIGNA [1260]|CIGNA [126008]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|BCBS [1155]|TULSA BLUE [115531]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UMR [2035]|UMR CORE [203505]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|CORESOURCE [1315]|CORESOURCE [131501]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|GEHA [1415]|GEHA - ASA [141503]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|78.13||||78.13|||
102018|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TEMPUS L12 MM OD4.5 MM SPINE SELF TAP VARIABLE ANGLE NONSTERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|78.13||||78.13|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|8486.75||||8486.75|3252.97|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|CORESOURCE [1315]|CORESOURCE [131501]|8486.75||||8486.75|3252.97|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|8486.75||||8486.75|3819.04|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|8486.75||||8486.75|3252.97|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|8486.75||||8486.75|3479.57|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|8486.75||||8486.75|3819.04|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8486.75||||8486.75|2195.52|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|8486.75||||8486.75|4328.24|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|<Self-pay>|<Self-pay>|8486.75||||8486.75|2121.69|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|8486.75||||8486.75|3252.97|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|AETNA [1015]|AETNA ACO WILCO [101532]|8486.75||||8486.75|3252.97|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|8486.75||||8486.75|4667.71|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|8486.75||||8486.75|3252.97|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|8486.75||||8486.75|3252.97|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|8486.75||||8486.75|3479.57|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|8486.75||||8486.75|3479.57|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|8486.75||||8486.75|3819.04|4667.71|2121.69
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|GEHA [1415]|GEHA - ASA [141503]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UMR [2035]|UMR CORE [203505]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|BCBS [1155]|TULSA BLUE [115531]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|CIGNA [1260]|CIGNA [126008]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|8486.75||||8486.75|||
102051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT BONE TRINITY ELITE CANCELLOUS MEDIUM ALLOGRAFT FROZEN VIABLE CELL MORSELIZE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|8486.75||||8486.75|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1112.20||||1112.20|500.49|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1112.20||||1112.20|287.73|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1112.20||||1112.20|456|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1112.20||||1112.20|456|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1112.20||||1112.20|444.88|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1112.20||||1112.20|444.88|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|<Self-pay>|<Self-pay>|1112.20||||1112.20|278.05|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1112.20||||1112.20|567.22|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|AETNA [1015]|AETNA ACO WILCO [101532]|1112.20||||1112.20|444.88|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1112.20||||1112.20|500.49|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1112.20||||1112.20|456|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1112.20||||1112.20|444.88|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|CORESOURCE [1315]|CORESOURCE [131501]|1112.20||||1112.20|444.88|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1112.20||||1112.20|444.88|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1112.20||||1112.20|611.71|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1112.20||||1112.20|444.88|611.71|278.05
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|CIGNA [1260]|CIGNA [126008]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UMR [2035]|UMR CORE [203505]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|BCBS [1155]|TULSA BLUE [115531]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|GEHA [1415]|GEHA - ASA [141503]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1112.20||||1112.20|||
102058|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|WAND ELECTROSURGICAL COBLATOR REFLEX ULTRA 55 PLASMA SUCTION MINIMALLY INVASIVE TURBINATE REDUCTION DISTAL ABLATIVE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1112.20||||1112.20|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3888.38||||3888.38|1490.42|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3888.38||||3888.38|1749.77|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|CORESOURCE [1315]|CORESOURCE [131501]|3888.38||||3888.38|1490.42|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3888.38||||3888.38|1490.42|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3888.38||||3888.38|1594.24|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3888.38||||3888.38|1749.77|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3888.38||||3888.38|1983.08|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|<Self-pay>|<Self-pay>|3888.38||||3888.38|972.09|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3888.38||||3888.38|1490.42|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|AETNA [1015]|AETNA ACO WILCO [101532]|3888.38||||3888.38|1490.42|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3888.38||||3888.38|2138.61|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3888.38||||3888.38|1490.42|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3888.38||||3888.38|1490.42|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3888.38||||3888.38|1594.24|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3888.38||||3888.38|1594.24|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3888.38||||3888.38|1005.92|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3888.38||||3888.38|1749.77|2138.61|972.09
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|GEHA [1415]|GEHA - ASA [141503]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UMR [2035]|UMR CORE [203505]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|BCBS [1155]|TULSA BLUE [115531]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|CIGNA [1260]|CIGNA [126008]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3888.38||||3888.38|||
102091|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL 10MM TRIATHLON 7 LEFT MEDIAL RIGHT LATERAL TOTAL STABILIZE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|3888.38||||3888.38|1749.77|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3888.38||||3888.38|1005.92|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|3888.38||||3888.38|1594.24|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|3888.38||||3888.38|1594.24|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3888.38||||3888.38|1490.42|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|3888.38||||3888.38|1490.42|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|<Self-pay>|<Self-pay>|3888.38||||3888.38|972.09|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|3888.38||||3888.38|1983.08|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|AETNA [1015]|AETNA ACO WILCO [101532]|3888.38||||3888.38|1490.42|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|3888.38||||3888.38|1749.77|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|3888.38||||3888.38|1594.24|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|3888.38||||3888.38|1490.42|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|CORESOURCE [1315]|CORESOURCE [131501]|3888.38||||3888.38|1490.42|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|3888.38||||3888.38|1749.77|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|3888.38||||3888.38|1490.42|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|3888.38||||3888.38|2138.61|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3888.38||||3888.38|1490.42|2138.61|972.09
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|CIGNA [1260]|CIGNA [126008]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|BCBS [1155]|TULSA BLUE [115531]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UMR [2035]|UMR CORE [203505]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|GEHA [1415]|GEHA - ASA [141503]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|3888.38||||3888.38|||
102092|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AUGMENT TIBIAL TRIATHLON 7 H10 MM RIGHT MEDIAL LEFT LATERAL TOTAL STABILIZE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|3888.38||||3888.38|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|14.75||||14.75|6.05|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|14.75||||14.75|7.52|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|14.75||||14.75|6.05|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|14.75||||14.75|6.64|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.75||||14.75|3.82|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|14.75||||14.75|6.64|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|14.75||||14.75|6.64|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|14.75||||14.75|6.64|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|14.75||||14.75|8.11|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|<Self-pay>|<Self-pay>|14.75||||14.75|3.69|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CORESOURCE [1315]|CORESOURCE [131501]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|14.75||||14.75|6.05|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14.75||||14.75|3.82|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|<Self-pay>|<Self-pay>|14.75||||14.75|3.69|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|14.75||||14.75|6.05|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|14.75||||14.75|8.11|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|14.75||||14.75|6.05|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|14.75||||14.75|5.9|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|14.75||||14.75|6.05|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|14.75||||14.75|7.52|8.11|3.69
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA [1260]|CIGNA [126008]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA [1260]|CIGNA [126008]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|TULSA BLUE [115531]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR [2035]|UMR CORE [203505]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GEHA [1415]|GEHA - ASA [141503]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UMR [2035]|UMR CORE [203505]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|14.75||||14.75|||
10235|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|HYDROXYCHLOROQUINE 200 MG TABLET|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|14.75||||14.75|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|AETNA [1015]|AETNA ACO WILCO [101532]|5602.50||||5602.50|2147.44|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5602.50||||5602.50|2147.44|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5602.50||||5602.50|2147.44|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5602.50||||5602.50|2521.13|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5602.50||||5602.50|2297.03|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5602.50||||5602.50|2147.44|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5602.50||||5602.50|2297.03|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5602.50||||5602.50|2521.13|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5602.50||||5602.50|2147.44|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5602.50||||5602.50|2857.28|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5602.50||||5602.50|2521.13|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|CORESOURCE [1315]|CORESOURCE [131501]|5602.50||||5602.50|2147.44|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|<Self-pay>|<Self-pay>|5602.50||||5602.50|1400.62|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5602.50||||5602.50|3081.38|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5602.50||||5602.50|2147.44|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5602.50||||5602.50|1449.37|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5602.50||||5602.50|2297.03|3081.38|1400.62
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|BCBS [1155]|TULSA BLUE [115531]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UMR [2035]|UMR CORE [203505]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|GEHA [1415]|GEHA - ASA [141503]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|CIGNA [1260]|CIGNA [126008]|5602.50||||5602.50|||
10240|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|PLATE CERVICAL 2 LEVEL 32MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5602.50||||5602.50|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|13.66||||13.66|5.46|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|13.66||||13.66|7.51|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|13.66||||13.66|5.46|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|<Self-pay>|<Self-pay>|13.66||||13.66|3.41|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|13.66||||13.66|5.46|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|13.66||||13.66|5.6|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CORESOURCE [1315]|CORESOURCE [131501]|13.66||||13.66|5.46|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|13.66||||13.66|6.15|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|13.66||||13.66|5.46|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|13.66||||13.66|6.15|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|13.66||||13.66|5.6|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|13.66||||13.66|5.46|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|13.66||||13.66|5.6|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13.66||||13.66|3.53|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|13.66||||13.66|6.97|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|13.66||||13.66|5.46|7.51|3.41
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GEHA [1415]|GEHA - ASA [141503]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UMR [2035]|UMR CORE [203505]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|CIGNA [1260]|CIGNA [126008]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|TULSA BLUE [115531]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13.66||||13.66|||
10246|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|IBUPROFEN 100 MG/5 ML ORAL SUSPENSION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|13.66||||13.66|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25730.00||||25730.00|6656.35|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|25730.00||||25730.00|9862.31|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25730.00||||25730.00|9862.31|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|25730.00||||25730.00|10549.3|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25730.00||||25730.00|9862.31|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|25730.00||||25730.00|10549.3|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|25730.00||||25730.00|11578.5|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|<Self-pay>|<Self-pay>|25730.00||||25730.00|6432.5|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|25730.00||||25730.00|11578.5|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|25730.00||||25730.00|13122.3|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|25730.00||||25730.00|14151.5|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|CORESOURCE [1315]|CORESOURCE [131501]|25730.00||||25730.00|9862.31|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25730.00||||25730.00|9862.31|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|25730.00||||25730.00|11578.5|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|25730.00||||25730.00|9862.31|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|25730.00||||25730.00|10549.3|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25730.00||||25730.00|9862.31|14151.5|6432.5
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|CIGNA [1260]|CIGNA [126008]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|GEHA [1415]|GEHA - ASA [141503]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|BCBS [1155]|TULSA BLUE [115531]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|UMR [2035]|UMR CORE [203505]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|25730.00||||25730.00|||
102461|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|DISC INTERVERTEBRAL MOBI-C COCRMO TITANIUM UHMWPE HA D13 MM W15 MM X H6 MM SPINE CERVICAL FLAT SPHERICAL PLATE MOBILE INSERT STERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|25730.00||||25730.00|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|AETNA [1015]|AETNA ACO WILCO [101532]|1607.69||||1607.69|643.08|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1607.69||||1607.69|659.15|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1607.69||||1607.69|659.15|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1607.69||||1607.69|643.08|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1607.69||||1607.69|643.08|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|<Self-pay>|<Self-pay>|1607.69||||1607.69|401.92|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1607.69||||1607.69|819.92|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1607.69||||1607.69|723.46|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1607.69||||1607.69|415.91|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1607.69||||1607.69|884.23|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|CORESOURCE [1315]|CORESOURCE [131501]|1607.69||||1607.69|643.08|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1607.69||||1607.69|643.08|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1607.69||||1607.69|643.08|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1607.69||||1607.69|723.46|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1607.69||||1607.69|659.15|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1607.69||||1607.69|643.08|884.23|401.92
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|BCBS [1155]|TULSA BLUE [115531]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|CIGNA [1260]|CIGNA [126008]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UMR [2035]|UMR CORE [203505]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|GEHA [1415]|GEHA - ASA [141503]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1607.69||||1607.69|||
102496|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CURETTE ENDOSCOPIC IVAS OD10 GA LATEX FREE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1607.69||||1607.69|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|558.17||||558.17|228.85|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|558.17||||558.17|144.4|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|558.17||||558.17|144.4|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|558.17||||558.17|228.85|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|558.17||||558.17|228.85|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|558.17||||558.17|284.67|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|558.17||||558.17|251.18|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|558.17||||558.17|251.18|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|558.17||||558.17|228.85|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|558.17||||558.17|228.85|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|558.17||||558.17|284.67|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|558.17||||558.17|251.18|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|<Self-pay>|<Self-pay>|558.17||||558.17|139.54|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|558.17||||558.17|251.18|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|558.17||||558.17|228.85|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|<Self-pay>|<Self-pay>|558.17||||558.17|139.54|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131501]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|CORESOURCE [1315]|CORESOURCE [131501]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|558.17||||558.17|306.99|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|558.17||||558.17|223.27|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|558.17||||558.17|306.99|306.99|139.54
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|TULSA BLUE [115531]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BCBS [1155]|TULSA BLUE [115531]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UMR [2035]|UMR CORE [203505]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UMR [2035]|UMR CORE [203505]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|CIGNA [1260]|CIGNA [126008]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GEHA [1415]|GEHA - ASA [141503]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|GEHA [1415]|GEHA - ASA [141503]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|558.17||||558.17|||
10266|ERX|0250 - PHARMACY-GENERAL|INDOCYANINE GREEN 25 MG SOLUTION FOR INJECTION|CIGNA [1260]|CIGNA [126008]|558.17||||558.17|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|176.80||||176.80|70.72|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|176.80||||176.80|70.72|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176.80||||176.80|70.72|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|CORESOURCE [1315]|CORESOURCE [131501]|176.80||||176.80|70.72|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|176.80||||176.80|79.56|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|176.80||||176.80|72.49|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|176.80||||176.80|90.17|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176.80||||176.80|45.74|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|<Self-pay>|<Self-pay>|176.80||||176.80|44.2|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|176.80||||176.80|72.49|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|AETNA [1015]|AETNA ACO WILCO [101532]|176.80||||176.80|70.72|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|176.80||||176.80|72.49|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|176.80||||176.80|70.72|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|176.80||||176.80|97.24|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|176.80||||176.80|79.56|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176.80||||176.80|70.72|97.24|44.2
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|GEHA [1415]|GEHA - ASA [141503]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UMR [2035]|UMR CORE [203505]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|CIGNA [1260]|CIGNA [126008]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|BCBS [1155]|TULSA BLUE [115531]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176.80||||176.80|||
102713|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC PIGMENT STERILE FLESH 5|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|176.80||||176.80|79.56|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|176.80||||176.80|72.49|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|176.80||||176.80|70.72|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|176.80||||176.80|79.56|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|<Self-pay>|<Self-pay>|176.80||||176.80|44.2|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|176.80||||176.80|90.17|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|176.80||||176.80|72.49|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|176.80||||176.80|70.72|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|AETNA [1015]|AETNA ACO WILCO [101532]|176.80||||176.80|70.72|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|176.80||||176.80|45.74|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|176.80||||176.80|70.72|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|CORESOURCE [1315]|CORESOURCE [131501]|176.80||||176.80|70.72|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|176.80||||176.80|97.24|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|176.80||||176.80|70.72|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|176.80||||176.80|70.72|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|176.80||||176.80|72.49|97.24|44.2
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UMR [2035]|UMR CORE [203505]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|BCBS [1155]|TULSA BLUE [115531]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|CIGNA [1260]|CIGNA [126008]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|GEHA [1415]|GEHA - ASA [141503]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|176.80||||176.80|||
102715|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|INK TATTOO PERMARK HYPOALLERGENIC STERILE FLESH 10 ULTRAESSENCE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|176.80||||176.80|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1224.25||||1224.25|550.91|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1224.25||||1224.25|316.71|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1224.25||||1224.25|501.94|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1224.25||||1224.25|624.37|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|<Self-pay>|<Self-pay>|1224.25||||1224.25|306.06|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1224.25||||1224.25|489.7|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1224.25||||1224.25|489.7|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1224.25||||1224.25|501.94|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|CORESOURCE [1315]|CORESOURCE [131501]|1224.25||||1224.25|489.7|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1224.25||||1224.25|489.7|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1224.25||||1224.25|501.94|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|AETNA [1015]|AETNA ACO WILCO [101532]|1224.25||||1224.25|489.7|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1224.25||||1224.25|550.91|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1224.25||||1224.25|489.7|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1224.25||||1224.25|489.7|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1224.25||||1224.25|673.34|673.34|306.06
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UMR [2035]|UMR CORE [203505]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|BCBS [1155]|TULSA BLUE [115531]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|CIGNA [1260]|CIGNA [126008]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|GEHA [1415]|GEHA - ASA [141503]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1224.25||||1224.25|||
102727|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|PROCESSOR SOUND PHONE CLIP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1224.25||||1224.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|10408.25||||10408.25|4683.71|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|10408.25||||10408.25|4267.38|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|10408.25||||10408.25|3989.48|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|AETNA [1015]|AETNA ACO WILCO [101532]|10408.25||||10408.25|3989.48|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|10408.25||||10408.25|3989.48|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|<Self-pay>|<Self-pay>|10408.25||||10408.25|2602.06|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|10408.25||||10408.25|5308.21|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|10408.25||||10408.25|4267.38|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10408.25||||10408.25|2692.61|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|10408.25||||10408.25|2606.81|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|10408.25||||10408.25|3989.48|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|10408.25||||10408.25|2606.81|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|CORESOURCE [1315]|CORESOURCE [131501]|10408.25||||10408.25|3989.48|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|10408.25||||10408.25|4683.71|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|10408.25||||10408.25|3989.48|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|10408.25||||10408.25|4683.71|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|10408.25||||10408.25|2954.38|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|10408.25||||10408.25|5724.54|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|10408.25||||10408.25|3989.48|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|10408.25||||10408.25|2954.38|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|10408.25||||10408.25|4267.38|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|10408.25||||10408.25|1737.87|5724.54|1737.87
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|BCBS [1155]|TULSA BLUE [115531]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|CIGNA [1260]|CIGNA [126008]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UMR [2035]|UMR CORE [203505]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|10408.25||||10408.25|||
102728|SUP|0274 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PROST|PROCESSOR SOUND BROWN 26X19X12MM COCHLEAR BAHA 5 BLUETOOTH BCDRIVE 1.4MA 1.9MA 250-7000HZ 250-6300HZ 17 CHANNEL ANALYSIS 2 TRACK FEEDBACK MANAGER FULL PROGRAMMABLE MICROPHONE 9.8GM|GEHA [1415]|GEHA - ASA [141503]|10408.25||||10408.25|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|66.20||||66.20|36.41|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|66.20||||66.20|26.48|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|66.20||||66.20|17.12|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|66.20||||66.20|26.48|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|66.20||||66.20|27.14|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|<Self-pay>|<Self-pay>|66.20||||66.20|16.55|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|66.20||||66.20|33.76|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|66.20||||66.20|26.48|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|CORESOURCE [1315]|CORESOURCE [131501]|66.20||||66.20|26.48|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|66.20||||66.20|26.48|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|66.20||||66.20|26.48|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|66.20||||66.20|29.79|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|66.20||||66.20|27.14|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|66.20||||66.20|27.14|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|AETNA [1015]|AETNA ACO WILCO [101532]|66.20||||66.20|26.48|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|66.20||||66.20|29.79|36.41|16.55
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|GEHA [1415]|GEHA - ASA [141503]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|BCBS [1155]|TULSA BLUE [115531]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|CIGNA [1260]|CIGNA [126008]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|UMR [2035]|UMR CORE [203505]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|66.20||||66.20|||
10278|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|NEEDLE NERVE STIMULATOR STIMUPLEX A PVC 30 D L4 IN OD21 GA BEVEL INSULATE INTEGRATE EXTENSION TUBE DEHP FREE STERILE LATEX FREE 1 SHOT PERIPHERAL BLOCK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|66.20||||66.20|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|AETNA [1015]|AETNA ACO WILCO [101532]|25.06||||25.06|10.03|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|25.06||||25.06|12.78|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|<Self-pay>|<Self-pay>|25.06||||25.06|6.26|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.06||||25.06|10.03|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|25.06||||25.06|11.28|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|25.06||||25.06|10.28|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|25.06||||25.06|10.28|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|25.06||||25.06|10.03|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|25.06||||25.06|11.28|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|25.06||||25.06|10.28|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|CORESOURCE [1315]|CORESOURCE [131501]|25.06||||25.06|10.03|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|25.06||||25.06|10.03|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|25.06||||25.06|10.03|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.06||||25.06|6.48|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.06||||25.06|10.03|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|25.06||||25.06|13.78|13.78|6.26
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|CIGNA [1260]|CIGNA [126008]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|BCBS [1155]|TULSA BLUE [115531]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UMR [2035]|UMR CORE [203505]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|GEHA [1415]|GEHA - ASA [141503]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|25.06||||25.06|||
102811|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER URETHRAL DOVER SILICONE OD12 FR 10 ML FOLEY 2 WAY LARGE SMOOTH DRAINAGE EYE FIRM TIP STERILE LATEX FREE BLUE STRIPE CLEAR|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|25.06||||25.06|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|774.80||||774.80|426.14|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|774.80||||774.80|348.66|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|774.80||||774.80|395.15|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|CIGNA [1260]|CIGNA [126008]|774.80||||774.80|503.62|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|774.80||||774.80|317.67|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|774.80||||774.80|317.67|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|774.80||||774.80|200.44|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|774.80||||774.80|178.19|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|774.80||||774.80|348.66|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|774.80||||774.80|317.67|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|774.80||||774.80|178.19|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|<Self-pay>|<Self-pay>|774.80||||774.80|193.7|503.62|178.19
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|CORESOURCE [1315]|CORESOURCE [131501]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|GEHA [1415]|GEHA - ASA [141503]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|BCBS [1155]|TULSA BLUE [115531]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|AETNA [1015]|AETNA ACO WILCO [101532]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|UMR [2035]|UMR CORE [203505]|774.80||||774.80|||
102833|SUP|0276 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-INTRA|LENS INTRAOCULAR ACRYSOF NATURAL MONOFLEX 10 D +11 DIOPTER MODIFIED C BICONVEX L13 MM OD6 MM POSTERIOR CHAMBER MULTIPIECE FOLDABLE ANTERIOR ASYMMETRIC UV BLUE LIGHT FILTER STERILE BLUE APHAKIA 118.4 A|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|774.80||||774.80|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CORESOURCE [1315]|CORESOURCE [131501]|86.52||||86.52|34.61|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.52||||86.52|57|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.52||||86.52|57|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.52||||86.52|22.38|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.52||||86.52|35.47|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.52||||86.52|34.61|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA [1015]|AETNA ACO WILCO [101532]|86.52||||86.52|34.61|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.52||||86.52|34.61|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.52||||86.52|44.13|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.52||||86.52|38.93|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.52||||86.52|38.93|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.52||||86.52|34.61|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.52||||86.52|35.47|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.52||||86.52|34.61|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.52||||86.52|47.59|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.52||||86.52|34.61|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|<Self-pay>|<Self-pay>|86.52||||86.52|21.63|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.52||||86.52|35.47|57|21.63
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|TULSA BLUE [115531]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CIGNA [1260]|CIGNA [126008]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UMR [2035]|UMR CORE [203505]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|GEHA [1415]|GEHA - ASA [141503]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.52||||86.52|||
10284|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN NPH ISOPHANE U-100 HUMAN 100 UNIT/ML SUBCUTANEOUS SUSPENSION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.52||||86.52|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|5241.24||||5241.24|2882.68|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|5241.24||||5241.24|2358.56|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|5241.24||||5241.24|2008.97|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|<Self-pay>|<Self-pay>|5241.24||||5241.24|1310.31|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|5241.24||||5241.24|2008.97|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5241.24||||5241.24|2008.97|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|5241.24||||5241.24|2148.91|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|5241.24||||5241.24|2673.03|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|5241.24||||5241.24|2148.91|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|5241.24||||5241.24|2148.91|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5241.24||||5241.24|1355.91|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|5241.24||||5241.24|2008.97|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|AETNA [1015]|AETNA ACO WILCO [101532]|5241.24||||5241.24|2008.97|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|CORESOURCE [1315]|CORESOURCE [131501]|5241.24||||5241.24|2008.97|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5241.24||||5241.24|2008.97|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|5241.24||||5241.24|2358.56|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|5241.24||||5241.24|2358.56|2882.68|1310.31
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|CIGNA [1260]|CIGNA [126008]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|BCBS [1155]|TULSA BLUE [115531]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|UMR [2035]|UMR CORE [203505]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|GEHA [1415]|GEHA - ASA [141503]|5241.24||||5241.24|||
102857|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GUIDE NERVE NEUROMEND COLLAGEN 4 MM L2.5 CM OD4 MM ODSEC2-3 MM|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|5241.24||||5241.24|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA [1015]|AETNA ACO WILCO [101532]|86.52||||86.52|34.61|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.52||||86.52|22.38|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.52||||86.52|35.47|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.52||||86.52|34.61|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.52||||86.52|35.47|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.52||||86.52|57|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.52||||86.52|34.61|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.52||||86.52|44.13|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.52||||86.52|38.93|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.52||||86.52|35.47|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.52||||86.52|38.93|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.52||||86.52|57|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.52||||86.52|34.61|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CORESOURCE [1315]|CORESOURCE [131501]|86.52||||86.52|34.61|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.52||||86.52|34.61|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.52||||86.52|34.61|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|<Self-pay>|<Self-pay>|86.52||||86.52|21.63|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.52||||86.52|47.59|57|21.63
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UMR [2035]|UMR CORE [203505]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|TULSA BLUE [115531]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|CIGNA [1260]|CIGNA [126008]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|GEHA [1415]|GEHA - ASA [141503]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.52||||86.52|||
10286|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN HUMAN U-100 NPH-REGULR 70-30 MIX 100 UNIT/ML SUBCUTANEOUS SUSP|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|86.52||||86.52|22.38|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|86.52||||86.52|34.61|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|86.52||||86.52|35.47|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|86.52||||86.52|34.61|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|86.52||||86.52|34.61|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CORESOURCE [1315]|CORESOURCE [131501]|86.52||||86.52|34.61|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|86.52||||86.52|38.93|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|86.52||||86.52|57|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|86.52||||86.52|35.47|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|<Self-pay>|<Self-pay>|86.52||||86.52|21.63|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|86.52||||86.52|34.61|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|86.52||||86.52|47.59|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|86.52||||86.52|34.61|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|86.52||||86.52|44.13|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|86.52||||86.52|35.47|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|86.52||||86.52|57|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|86.52||||86.52|34.61|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|86.52||||86.52|38.93|57|21.63
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GEHA [1415]|GEHA - ASA [141503]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UMR [2035]|UMR CORE [203505]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|CIGNA [1260]|CIGNA [126008]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|TULSA BLUE [115531]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|86.52||||86.52|||
10289|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|INSULIN U-100 REGULAR HUMAN 100 UNIT/ML INJECTION SOLUTION|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|86.52||||86.52|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12.86||||12.86|3.33|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|12.86||||12.86|5.27|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12.86||||12.86|5.14|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AETNA [1015]|AETNA ACO WILCO [101532]|12.86||||12.86|5.14|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|12.86||||12.86|5.14|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|<Self-pay>|<Self-pay>|12.86||||12.86|3.21|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|12.86||||12.86|6.56|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|12.86||||12.86|5.27|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|12.86||||12.86|5.79|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|12.86||||12.86|5.14|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|12.86||||12.86|5.27|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CORESOURCE [1315]|CORESOURCE [131501]|12.86||||12.86|5.14|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|12.86||||12.86|5.79|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|12.86||||12.86|5.14|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|12.86||||12.86|7.07|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12.86||||12.86|5.14|7.07|3.21
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|TULSA BLUE [115531]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CIGNA [1260]|CIGNA [126008]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UMR [2035]|UMR CORE [203505]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|GEHA [1415]|GEHA - ASA [141503]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|12.86||||12.86|||
103|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|ACETAMINOPHEN 120 MG RECTAL SUPPOSITORY|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|12.86||||12.86|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1612.00||||1612.00|886.6|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1612.00||||1612.00|725.4|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1612.00||||1612.00|617.88|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1612.00||||1612.00|725.4|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1612.00||||1612.00|660.92|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1612.00||||1612.00|617.88|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1612.00||||1612.00|617.88|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1612.00||||1612.00|617.88|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|CORESOURCE [1315]|CORESOURCE [131501]|1612.00||||1612.00|617.88|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|AETNA [1015]|AETNA ACO WILCO [101532]|1612.00||||1612.00|617.88|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1612.00||||1612.00|617.88|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1612.00||||1612.00|660.92|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|<Self-pay>|<Self-pay>|1612.00||||1612.00|403|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1612.00||||1612.00|660.92|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1612.00||||1612.00|725.4|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1612.00||||1612.00|417.02|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1612.00||||1612.00|822.12|886.6|403
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|GEHA [1415]|GEHA - ASA [141503]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|BCBS [1155]|TULSA BLUE [115531]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|UMR [2035]|UMR CORE [203505]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|CIGNA [1260]|CIGNA [126008]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1612.00||||1612.00|||
103057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM L14 MM OD2.7 MM FOOT LOCK LOW PROFILE STERILE BLUE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1612.00||||1612.00|617.88|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|CORESOURCE [1315]|CORESOURCE [131501]|1612.00||||1612.00|617.88|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1612.00||||1612.00|725.4|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1612.00||||1612.00|617.88|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1612.00||||1612.00|886.6|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1612.00||||1612.00|617.88|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1612.00||||1612.00|660.92|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1612.00||||1612.00|725.4|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1612.00||||1612.00|660.92|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1612.00||||1612.00|417.02|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1612.00||||1612.00|617.88|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AETNA [1015]|AETNA ACO WILCO [101532]|1612.00||||1612.00|617.88|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1612.00||||1612.00|617.88|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|<Self-pay>|<Self-pay>|1612.00||||1612.00|403|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1612.00||||1612.00|822.12|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1612.00||||1612.00|660.92|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1612.00||||1612.00|725.4|886.6|403
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GEHA [1415]|GEHA - ASA [141503]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|CIGNA [1260]|CIGNA [126008]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|TULSA BLUE [115531]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1612.00||||1612.00|||
103058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L16 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UMR [2035]|UMR CORE [203505]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1612.00||||1612.00|617.88|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1612.00||||1612.00|886.6|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|CORESOURCE [1315]|CORESOURCE [131501]|1612.00||||1612.00|617.88|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MERITAIN HEALTH [1655]|MERITAIN HEALTH [165500]|1612.00||||1612.00|617.88|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1612.00||||1612.00|660.92|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1612.00||||1612.00|725.4|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|<Self-pay>|<Self-pay>|1612.00||||1612.00|403|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHSCOPE BENEFITS [2290]|HEALTHSCOPE BENEFITS [229000]|1612.00||||1612.00|617.88|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1612.00||||1612.00|725.4|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AETNA [1015]|AETNA ACO WILCO [101532]|1612.00||||1612.00|617.88|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1612.00||||1612.00|617.88|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1612.00||||1612.00|822.12|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|ALLIED BENEFIT SYSTEMS INC [1030]|ALLIED BENEFIT SYSTEMS [103000]|1612.00||||1612.00|617.88|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1612.00||||1612.00|660.92|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1612.00||||1612.00|660.92|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1612.00||||1612.00|417.02|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1612.00||||1612.00|725.4|886.6|403
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|COMMUNITY CARE MEDICARE [1125]|COMMUNITY CARE ADVANTAGE MEDICARE [112502]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GEHA [1415]|GEHA - ASA [141503]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GLOBAL HEALTH [1430]|GLOBAL HEALTH COMMERCIAL [143000]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE [206025]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE [2060]|UNITED HEALTHCARE CHARTER [206031]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED COMMERCIAL [2055]|UNITED COMMERCIAL TRAVELERS [205500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MOLINA MEDICARE REPLACEMENT [1675]|MOLINA MEDICARE ADVANTAGE [167500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA MEDICARE REPLACEMENT [102002]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HEALTHCHOICE [1490]|HEALTHCHOICE [149000]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AMERIGROUP MEDICAID [1095]|AMERIGROUP MEDICAID [109500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|CIGNA MEDICARE REPLACEMENT [1265]|CIGNA MEDICARE REPLACEMENT [126500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC CARE IMP PLUS MEDICARE ADV [206508]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|AMERIGROUP MEDICARE [1100]|AMERIGROUP MEDICARE [110000]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BEACON HEALTH OPTIONS BEHAVIORAL HEALTH [2890]|BEACON HEALTH OPTIONS [289000]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|TULSA BLUE [115531]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|UMR [2035]|UMR CORE [203505]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|CIGNA [1260]|CIGNA [126008]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|LIFE SENIOR SERVICES [2425]|LIFE SENIOR SERVICES [242501]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|GHI [2835]|GHI MEDICARE REPLACEMENT [283500]|1612.00||||1612.00|||
103059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L18 MM OD2.7 MM LOCK LOW PROFILE TORX DRIVE STERILE BLUE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1612.00||||1612.00|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|KEMPTON GROUP ADMINISTRATORS [2905]|ADVANTAGE HEALTH PLAN-NO PPO NETWORK [290503]|1193.40||||1193.40|537.03|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|UNIVERSAL FIDELITY [2085]|UNIVERSAL FIDELITY LIFE [208500]|1193.40||||1193.40|489.29|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|<Self-pay>|<Self-pay>|1193.40||||1193.40|298.35|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|HUMANA COMMERCIAL [2140]|HUMANA CHOICECARE [214003]|1193.40||||1193.40|608.63|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|OSMA HEALTH NETWORK [2345]|OSMA HEALTH [234500]|1193.40||||1193.40|537.03|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|RESOURCE ONE ADMINISTRATORS [2815]|RESOURCE ONE ADMINISTRATORS [281500]|1193.40||||1193.40|489.29|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1193.40||||1193.40|308.73|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|HEALTHCARE HIGHWAYS [2210]|HEALTHCARE HIGHWAYS HEALTH PLAN [221009]|1193.40||||1193.40|489.29|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|HEALTHCARE SOLUTIONS [1485]|HEALTHCARE SOLUTIONS GROUP [148500]|1193.40||||1193.40|537.03|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|DEPARTMENT OF CORRECTIONS [1340]|PARKSIDE [134007]|1193.40||||1193.40|656.37|656.37|298.35
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|HPSI [1520]|HPSI HEALTHPLAN SERVICE [152000]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|DEPARTMENT OF REHABILITATION SERVICES [2355]|DEPARTMENT OF REHABILITATION SERVICES [235500]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|CIGNA [1260]|CIGNA [126008]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|BCBS [1155]|BLUE CROSS CHEROKEE MLR OF OKLAHOMA [115509]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|BCBS [1155]|BLUE CROSS ADVANTAGE OF ARKANSAS [115536]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|BCBS [1155]|BLUE CROSS PREFERRED OF OKLAHOMA [115500]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|BCBS [1155]|BLUE CROSS TRADITIONAL OF OKLAHOMA [115501]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|GENERATIONS HEALTHCARE [1420]|GENERATIONS HEALTHCARE [142000]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|GENERATIONS MEDICARE ADVANTAGE [1435]|GLOBAL GENERATIONS MEDICARE ADVANTAGE [143500]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ULTOS TITANIUM T8 L14 MM OD2.7 MM LOW PROFILE COLOR CODED TORX STERILE|UMR [2035]|UMR CORE [203505]|1193.40||||1193.40|||
103060|SUP|0278 - MEDICAL/SUR