"Procedure"|"Code Type"|"Revenue Code"|"Procedure Description"|"Payer"|"Plan"|"Inpatient Gross Charges"|"Inpatient Expected Reimbursement"|"Inpatient Max Reimbursement"|"Inpatient Minimal Reimbursement"|"Outpatient Gross Charges"|"Outpatient Expected Reimbursement"|"Outpatient Max Reimbursement"|"Outpatient Minimal Reimbursement"
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4616.49||||4616.49|4154.84|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4616.49||||4616.49|2668.33|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA PPO [126025]|4616.49||||4616.49|2668.33|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA ACO WILCO [101532]|4616.49||||4616.49|3107.82|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4616.49||||4616.49|3587.01|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4616.49||||4616.49|3587.01|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|HMA [168003]|4616.49||||4616.49|3587.01|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4616.49||||4616.49|3587.01|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4616.49||||4616.49|2668.33|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4616.49||||4616.49|3924.02|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4616.49||||4616.49|2668.33|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4616.49||||4616.49|3107.82|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4616.49||||4616.49|3107.82|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS FEDERAL [115566]|4616.49||||4616.49|4154.84|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|4616.49||||4616.49|1384.95|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4616.49||||4616.49|3107.82|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4616.49||||4616.49|3231.54|4154.84|1384.95
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA [141500]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4616.49||||4616.49|||
100000|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|AXLE FEMORAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4616.49||||4616.49|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|<Self-pay>|<Self-pay>|268.95||||268.95|80.68|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|268.95||||268.95|208.97|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|268.95||||268.95|155.45|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|268.95||||268.95|166.75|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA [1015]|AETNA ACO WILCO [101532]|268.95||||268.95|181.06|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|268.95||||268.95|242.06|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|268.95||||268.95|181.06|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|268.95||||268.95|208.97|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|268.95||||268.95|181.06|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|268.95||||268.95|208.97|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|CIGNA [1260]|CIGNA PPO [126025]|268.95||||268.95|155.45|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|268.95||||268.95|181.06|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|MULTIPLAN [1680]|HMA [168003]|268.95||||268.95|208.97|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|268.95||||268.95|155.45|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|268.95||||268.95|155.45|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|268.95||||268.95|228.61|242.06|80.68
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|GEHA [1415]|GEHA [141500]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS [1155]|BCBS KS FEDERAL [115566]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|CHAMPVA [1240]|CHAMP VA [124000]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|268.95||||268.95|||
100011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|PALIPERIDONE ER 1.5 MG TABLET,EXTENDED RELEASE 24 HR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|268.95||||268.95|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|7857.78||||7857.78|3614.58|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AETNA [1015]|AETNA ACO WILCO [101532]|7857.78||||7857.78|5289.86|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|7857.78||||7857.78|6105.5|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|7857.78||||7857.78|5289.86|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|7857.78||||7857.78|6105.5|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MULTIPLAN [1680]|HMA [168003]|7857.78||||7857.78|6105.5|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|CIGNA [1260]|CIGNA PPO [126025]|7857.78||||7857.78|4541.8|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|GEHA [1415]|GEHA [141500]|7857.78||||7857.78|3614.58|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|7857.78||||7857.78|4541.8|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|7857.78||||7857.78|4541.8|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|7857.78||||7857.78|5500.45|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|7857.78||||7857.78|5289.86|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|7857.78||||7857.78|3614.58|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|7857.78||||7857.78|6105.5|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|7857.78||||7857.78|6679.11|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|7857.78||||7857.78|7072|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|7857.78||||7857.78|3614.58|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|<Self-pay>|<Self-pay>|7857.78||||7857.78|2357.33|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|BCBS [1155]|BCBS KS FEDERAL [115566]|7857.78||||7857.78|7072|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|7857.78||||7857.78|4541.8|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|7857.78||||7857.78|5289.86|7072|2357.33
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|CHAMPVA [1240]|CHAMP VA [124000]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|7857.78||||7857.78|||
100049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|MESH SURGICAL VENTRALIGHT ST SEPRA POLYPROPYLENE HYDROGEL RECTANGLE L14 IN X W12 IN UNCOATED MONOFILAMENT LIGHTWEIGHT ABSORBABLE LOW PROFILE STERILE LATEX FREE VENTRAL HERNIA REPAIR|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|7857.78||||7857.78|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|192.61||||192.61|111.33|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|129.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|192.61||||192.61|129.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|192.61||||192.61|149.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|192.61||||192.61|129.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|192.61||||192.61|149.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61|149.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|<Self-pay>|<Self-pay>|192.61||||192.61|57.78|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|192.61||||192.61|111.33|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|192.61||||192.61|111.33|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS FEDERAL [115566]|192.61||||192.61|173.35|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|192.61||||192.61|163.72|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|192.61||||192.61|173.35|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|149.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|192.61||||192.61|129.66|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|192.61||||192.61|111.33|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.61||||192.61|134.83|173.35|57.78
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|GEHA [1415]|GEHA [141500]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|192.61||||192.61|||
10006|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|192.61||||192.61|129.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|192.61||||192.61|149.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|<Self-pay>|<Self-pay>|192.61||||192.61|57.78|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|192.61||||192.61|111.33|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|192.61||||192.61|129.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|129.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|192.61||||192.61|163.72|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.61||||192.61|134.83|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|192.61||||192.61|173.35|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|192.61||||192.61|129.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|192.61||||192.61|111.33|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|149.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS FEDERAL [115566]|192.61||||192.61|173.35|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|192.61||||192.61|111.33|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|192.61||||192.61|111.33|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61|149.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|192.61||||192.61|149.66|173.35|57.78
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|GEHA [1415]|GEHA [141500]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|192.61||||192.61|||
10007|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L7 MM OD1.5 MM ODSEC3 MM CORTEX SELF TAP LOW PROFILE HEAD CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|192.61||||192.61|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|18.00||||18.00|15.3|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|18.00||||18.00|15.3|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|35.60||||35.60|23.97|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|35.60||||35.60|20.58|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|35.60||||35.60|10.68|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|18.00||||18.00|5.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|35.60||||35.60|30.26|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PPO [126025]|35.60||||35.60|20.58|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PPO [126025]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|18.00||||18.00|5.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|35.60||||35.60|20.58|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|35.60||||35.60|23.97|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|35.60||||35.60|27.66|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PPO [126025]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|35.60||||35.60|23.97|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|35.60||||35.60|27.66|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|18.00||||18.00|16.2|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|11.16|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|35.60||||35.60|22.07|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|18.00||||18.00|11.16|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|35.60||||35.60|20.58|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|18.00||||18.00|10.4|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|35.60||||35.60|32.04|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|35.60||||35.60|23.97|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|35.60||||35.60|27.66|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|18.00||||18.00|16.2|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|35.60||||35.60|27.66|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|18.00||||18.00|12.12|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|18.00||||18.00|13.99|32.04|5.4
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS FEDERAL [115566]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS FEDERAL [115566]|18.00||||18.00|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|35.60||||35.60|||
10009|ERX|0250 - PHARMACY-GENERAL|FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS FEDERAL [115566]|35.60||||35.60|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|192.61||||192.61|129.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61|149.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|192.61||||192.61|149.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|192.61||||192.61|149.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS FEDERAL [115566]|192.61||||192.61|173.35|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|192.61||||192.61|111.33|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|192.61||||192.61|111.33|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|192.61||||192.61|111.33|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|192.61||||192.61|129.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|192.61||||192.61|163.72|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|192.61||||192.61|111.33|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|192.61||||192.61|129.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|<Self-pay>|<Self-pay>|192.61||||192.61|57.78|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.61||||192.61|134.83|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|192.61||||192.61|173.35|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|129.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|149.66|173.35|57.78
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|GEHA [1415]|GEHA [141500]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|192.61||||192.61|||
10010|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L12 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|192.61||||192.61|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|16.35||||16.35|10.14|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|16.35||||16.35|13.9|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|<Self-pay>|<Self-pay>|16.35||||16.35|4.9|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|16.35||||16.35|9.45|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AETNA [1015]|AETNA ACO WILCO [101532]|16.35||||16.35|11.01|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MULTIPLAN [1680]|HMA [168003]|16.35||||16.35|12.71|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|16.35||||16.35|11.01|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|16.35||||16.35|12.71|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CIGNA [1260]|CIGNA PPO [126025]|16.35||||16.35|9.45|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|16.35||||16.35|14.72|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|16.35||||16.35|11.01|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|16.35||||16.35|9.45|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|16.35||||16.35|9.45|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|16.35||||16.35|12.71|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|16.35||||16.35|12.71|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|16.35||||16.35|11.01|14.72|4.9
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|CHAMPVA [1240]|CHAMP VA [124000]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|GEHA [1415]|GEHA [141500]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|BCBS [1155]|BCBS KS FEDERAL [115566]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|16.35||||16.35|||
100101|SUP|0270 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-GENER|TEST ASSESSMENT NEUROPATH MONOFILAMENT LATEX FREE DIABETIC FOOT ULCER|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|16.35||||16.35|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1113.53||||1113.53|643.62|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|<Self-pay>|<Self-pay>|1113.53||||1113.53|334.06|1002.17|334.06
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]|1113.53||||1113.53|749.63|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1113.53||||1113.53|865.21|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA PPO [126025]|1113.53||||1113.53|643.62|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|MULTIPLAN [1680]|HMA [168003]|1113.53||||1113.53|865.21|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1113.53||||1113.53|749.63|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1113.53||||1113.53|865.21|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1113.53||||1113.53|749.63|1002.17|334.06
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]|1113.53||||1113.53|749.63|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1113.53||||1113.53|643.62|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1113.53||||1113.53|1002.17|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1113.53||||1113.53|690.39|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1113.53||||1113.53|865.21|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1113.53||||1113.53|946.5|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1113.53||||1113.53|643.62|1002.17|334.06
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|GEHA [1415]|GEHA [141500]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|CHAMPVA [1240]|CHAMP VA [124000]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1113.53||||1113.53|||
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]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1113.53||||1113.53|||
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]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1113.53||||1113.53|||
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]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1113.53||||1113.53|||
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]|1113.53||||1113.53|||
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]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|BCBS [1155]|BCBS KS FEDERAL [115566]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1113.53||||1113.53|||
100106|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BIT DRILL STRAIGHT OD5 MM CANNULATED DISPOSABLE 7 MM SCREW|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1113.53||||1113.53|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|3531.99||||3531.99|2744.36|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BCBS KS FEDERAL [115566]|3531.99||||3531.99|3178.79|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA [1015]|AETNA ACO WILCO [101532]|3531.99||||3531.99|2377.74|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|3531.99||||3531.99|2472.39|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|3531.99||||3531.99|2041.49|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|3531.99||||3531.99|3002.19|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|3531.99||||3531.99|2041.49|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CIGNA [1260]|CIGNA PPO [126025]|3531.99||||3531.99|2041.49|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|3531.99||||3531.99|2377.74|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|3531.99||||3531.99|2377.74|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|3531.99||||3531.99|2744.36|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|<Self-pay>|<Self-pay>|3531.99||||3531.99|1059.6|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|3531.99||||3531.99|3178.79|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|3531.99||||3531.99|2744.36|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MULTIPLAN [1680]|HMA [168003]|3531.99||||3531.99|2744.36|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|3531.99||||3531.99|2041.49|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|3531.99||||3531.99|2377.74|3178.79|1059.6
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|GEHA [1415]|GEHA [141500]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|CHAMPVA [1240]|CHAMP VA [124000]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|3531.99||||3531.99|||
100108|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ARTHREX TITANIUM T25 XL FULL THREAD L50 MM OD7 MM COMPRESSION CANNULATION HEADLESS HEXALOBE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|3531.99||||3531.99|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|95.45||||95.45|74.16|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|GEHA [1415]|GEHA [141500]|95.45||||95.45|53.74|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CIGNA [1260]|CIGNA PPO [126025]|95.45||||95.45|55.17|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|MULTIPLAN [1680]|HMA [168003]|95.45||||95.45|74.16|85.9|28.64
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]|95.45||||95.45|64.25|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|95.45||||95.45|74.16|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|95.45||||95.45|53.74|85.9|28.64
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]|95.45||||95.45|64.25|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|95.45||||95.45|53.74|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|95.45||||95.45|64.25|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|95.45||||95.45|55.17|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|95.45||||95.45|55.17|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|95.45||||95.45|85.9|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|95.45||||95.45|81.13|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS [1155]|BCBS KS FEDERAL [115566]|95.45||||95.45|85.9|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|<Self-pay>|<Self-pay>|95.45||||95.45|28.64|85.9|28.64
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]|95.45||||95.45|64.25|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|95.45||||95.45|59.18|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|95.45||||95.45|55.17|85.9|28.64
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]|95.45||||95.45|53.74|85.9|28.64
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|95.45||||95.45|74.16|85.9|28.64
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]|95.45||||95.45|||
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]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|CHAMPVA [1240]|CHAMP VA [124000]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|95.45||||95.45|||
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]|95.45||||95.45|||
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]|95.45||||95.45|||
100109|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|GUIDEWIRE ORTHOPEDIC OD.094 IN TROCAR TIP DISPOSABLE 7 MM SCREW|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|95.45||||95.45|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10011|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FAMOTIDINE 20 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|HMA [168003]|2905.35||||2905.35|2257.45|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2905.35||||2905.35|2257.45|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|2905.35||||2905.35|2257.45|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA ACO WILCO [101532]|2905.35||||2905.35|1955.88|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|2905.35||||2905.35|871.61|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA PPO [126025]|2905.35||||2905.35|1679.29|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|2905.35||||2905.35|1679.29|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|2905.35||||2905.35|2614.81|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|2905.35||||2905.35|1955.88|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2905.35||||2905.35|1679.29|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|2905.35||||2905.35|2469.54|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2905.35||||2905.35|1955.88|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2905.35||||2905.35|2257.45|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2905.35||||2905.35|2033.74|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2905.35||||2905.35|1679.29|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS FEDERAL [115566]|2905.35||||2905.35|2614.81|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2905.35||||2905.35|1955.88|2614.81|871.61
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA [141500]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|2905.35||||2905.35|||
100110|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SLEEVE TIBIAL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2905.35||||2905.35|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|25.07||||25.07|14.49|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.07||||25.07|16.88|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|25.07||||25.07|14.49|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|25.07||||25.07|22.56|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|25.07||||25.07|21.31|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.07||||25.07|15.54|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|25.07||||25.07|16.88|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|25.07||||25.07|14.49|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|<Self-pay>|<Self-pay>|25.07||||25.07|7.52|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|25.07||||25.07|16.88|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.07||||25.07|19.48|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|25.07||||25.07|19.48|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.07||||25.07|16.88|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|25.07||||25.07|19.48|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA PPO [126025]|25.07||||25.07|14.49|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|HMA [168003]|25.07||||25.07|19.48|22.56|7.52
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BCBS KS FEDERAL [115566]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA [141500]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|25.07||||25.07|||
100124|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER METAL 00 ROUND TIP EDGE STERILE LATEX FREE DISPOSABLE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|25.07||||25.07|19.48|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.07||||25.07|16.88|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|25.07||||25.07|14.49|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|<Self-pay>|<Self-pay>|25.07||||25.07|7.52|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MULTIPLAN [1680]|HMA [168003]|25.07||||25.07|19.48|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CIGNA [1260]|CIGNA PPO [126025]|25.07||||25.07|14.49|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|25.07||||25.07|19.48|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|25.07||||25.07|16.88|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|25.07||||25.07|22.56|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|25.07||||25.07|21.31|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA [1015]|AETNA ACO WILCO [101532]|25.07||||25.07|16.88|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.07||||25.07|19.48|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|25.07||||25.07|14.49|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.07||||25.07|15.54|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.07||||25.07|16.88|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|25.07||||25.07|14.49|22.56|7.52
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|CHAMPVA [1240]|CHAMP VA [124000]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|GEHA [1415]|GEHA [141500]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|BCBS [1155]|BCBS KS FEDERAL [115566]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.07||||25.07|||
100125|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNG MILLER DISP SZ 0|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|25.07||||25.07|16.88|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|25.07||||25.07|15.54|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|25.07||||25.07|19.48|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|25.07||||25.07|22.56|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|25.07||||25.07|14.49|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|25.07||||25.07|14.49|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|25.07||||25.07|16.88|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|<Self-pay>|<Self-pay>|25.07||||25.07|7.52|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|25.07||||25.07|14.49|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AETNA [1015]|AETNA ACO WILCO [101532]|25.07||||25.07|16.88|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|25.07||||25.07|19.48|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CIGNA [1260]|CIGNA PPO [126025]|25.07||||25.07|14.49|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MULTIPLAN [1680]|HMA [168003]|25.07||||25.07|19.48|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|25.07||||25.07|19.48|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|25.07||||25.07|16.88|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|25.07||||25.07|21.31|22.56|7.52
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS [1155]|BCBS KS FEDERAL [115566]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|GEHA [1415]|GEHA [141500]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|CHAMPVA [1240]|CHAMP VA [124000]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|25.07||||25.07|||
100126|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|BLADE LARYNGOSCOPE BRITEBLADE PRO MILLER 1 METAL FIBER OPTIC HIGH INTENSITY ILLUMINATION LOW PROFILE HINGE STERILE LATEX FREE DISPOSABLE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|25.07||||25.07|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA PPO [126025]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA PPO [126025]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA PPO [126025]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CIGNA [1260]|CIGNA PPO [126025]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|730.00||||730.00|219|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|391.88||||391.88|117.56|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|730.00||||730.00|219|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|<Self-pay>|<Self-pay>|391.88||||391.88|117.56|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA [1015]|AETNA ACO WILCO [101532]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|730.00||||730.00|620.5|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|391.88||||391.88|333.1|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|391.88||||391.88|333.1|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|730.00||||730.00|620.5|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|730.00||||730.00|657|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|391.88||||391.88|352.69|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|730.00||||730.00|657|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|391.88||||391.88|352.69|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|391.88||||391.88|304.49|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MULTIPLAN [1680]|HMA [168003]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|730.00||||730.00|567.21|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|730.00||||730.00|421.94|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA [141500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA [141500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA [141500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS FEDERAL [115566]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS FEDERAL [115566]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS FEDERAL [115566]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|BCBS [1155]|BCBS KS FEDERAL [115566]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|GEHA [1415]|GEHA [141500]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|730.00||||730.00|491.44|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|391.88||||391.88|242.97|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|730.00||||730.00|452.6|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|391.88||||391.88|226.51|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|391.88||||391.88|242.97|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|391.88||||391.88|263.81|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|730.00||||730.00|452.6|657|117.56
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|CHAMPVA [1240]|CHAMP VA [124000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|391.88||||391.88|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|730.00||||730.00|||
10014|ERX|0250 - PHARMACY-GENERAL|FAT EMULSION 20 % INTRAVENOUS|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|391.88||||391.88|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|192.61||||192.61|129.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|192.61||||192.61|149.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|<Self-pay>|<Self-pay>|192.61||||192.61|57.78|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|192.61||||192.61|129.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|192.61||||192.61|111.33|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|192.61||||192.61|149.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MULTIPLAN [1680]|HMA [168003]|192.61||||192.61|149.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|192.61||||192.61|111.33|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|192.61||||192.61|129.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|192.61||||192.61|111.33|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|192.61||||192.61|149.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|192.61||||192.61|173.35|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|192.61||||192.61|163.72|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS [1155]|BCBS KS FEDERAL [115566]|192.61||||192.61|173.35|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|192.61||||192.61|111.33|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|192.61||||192.61|129.66|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|192.61||||192.61|134.83|173.35|57.78
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|GEHA [1415]|GEHA [141500]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|192.61||||192.61|||
10015|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L6 MM OD2 MM ODSEC3.5 MM CORTEX SELF TAP CRUCIFORM NONSTERILE MINI FRAGMENT SET MODULAR HAND SYSTEM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|192.61||||192.61|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100170|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 42MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100178|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 45MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100181|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 46MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100184|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 47MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100187|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 48MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|194.84||||194.84|131.16|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|194.84||||194.84|175.35|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|194.84||||194.84|112.61|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|194.84||||194.84|131.16|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|194.84||||194.84|151.39|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|194.84||||194.84|151.39|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|194.84||||194.84|131.16|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|194.84||||194.84|151.39|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|194.84||||194.84|112.61|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|194.84||||194.84|58.46|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|194.84||||194.84|112.61|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|194.84||||194.84|131.16|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|194.84||||194.84|165.61|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|194.84||||194.84|175.35|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.84||||194.84|151.39|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|194.84||||194.84|112.61|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.84||||194.84|136.38|175.35|58.46
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA [141500]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|194.84||||194.84|||
10019|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.84||||194.84|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100191|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 49MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100195|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 50MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100199|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 51MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|194.84||||194.84|131.16|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.84||||194.84|151.39|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|194.84||||194.84|175.35|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|194.84||||194.84|175.35|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|194.84||||194.84|112.61|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|194.84||||194.84|112.61|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|194.84||||194.84|131.16|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|194.84||||194.84|165.61|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|194.84||||194.84|131.16|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|194.84||||194.84|112.61|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|194.84||||194.84|151.39|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|194.84||||194.84|131.16|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.84||||194.84|136.38|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|194.84||||194.84|151.39|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|194.84||||194.84|151.39|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|194.84||||194.84|112.61|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|194.84||||194.84|58.46|175.35|58.46
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA [141500]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|194.84||||194.84|||
10020|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L18 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|194.84||||194.84|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100203|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 52MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|194.84||||194.84|131.16|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.84||||194.84|136.38|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|194.84||||194.84|112.61|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.84||||194.84|151.39|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|194.84||||194.84|175.35|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|194.84||||194.84|165.61|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|194.84||||194.84|112.61|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|194.84||||194.84|175.35|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|194.84||||194.84|131.16|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|194.84||||194.84|131.16|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|194.84||||194.84|112.61|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|194.84||||194.84|58.46|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|194.84||||194.84|151.39|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|194.84||||194.84|131.16|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|194.84||||194.84|151.39|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|194.84||||194.84|151.39|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|194.84||||194.84|112.61|175.35|58.46
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA [141500]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|194.84||||194.84|||
10021|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|194.84||||194.84|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1972.53||||1972.53|1532.66|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA [1015]|AETNA ACO WILCO [101532]|1972.53||||1972.53|1327.91|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CIGNA [1260]|CIGNA PPO [126025]|1972.53||||1972.53|1140.12|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|<Self-pay>|<Self-pay>|1972.53||||1972.53|591.76|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MULTIPLAN [1680]|HMA [168003]|1972.53||||1972.53|1532.66|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1972.53||||1972.53|1140.12|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1972.53||||1972.53|1327.91|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1972.53||||1972.53|1532.66|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1972.53||||1972.53|1327.91|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS FEDERAL [115566]|1972.53||||1972.53|1775.28|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1972.53||||1972.53|1676.65|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1972.53||||1972.53|1775.28|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1972.53||||1972.53|1140.12|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1972.53||||1972.53|1140.12|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1972.53||||1972.53|1532.66|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1972.53||||1972.53|1380.77|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1972.53||||1972.53|1327.91|1775.28|591.76
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|CHAMPVA [1240]|CHAMP VA [124000]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|GEHA [1415]|GEHA [141500]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1972.53||||1972.53|||
100215|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|HEAD BIPOLAR 55MM 26MM UHR UNIVERSAL HIP COCR UHMWPE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1972.53||||1972.53|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|194.84||||194.84|131.16|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.84||||194.84|136.38|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|194.84||||194.84|112.61|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.84||||194.84|151.39|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|194.84||||194.84|175.35|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|194.84||||194.84|165.61|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BCBS [1155]|BCBS KS FEDERAL [115566]|194.84||||194.84|175.35|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|194.84||||194.84|112.61|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|194.84||||194.84|131.16|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|194.84||||194.84|131.16|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|194.84||||194.84|112.61|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|194.84||||194.84|151.39|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|194.84||||194.84|131.16|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|194.84||||194.84|151.39|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MULTIPLAN [1680]|HMA [168003]|194.84||||194.84|151.39|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|<Self-pay>|<Self-pay>|194.84||||194.84|58.46|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|194.84||||194.84|112.61|175.35|58.46
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|GEHA [1415]|GEHA [141500]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|194.84||||194.84|||
10022|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD2.7 MM CORTEX SELF TAP NONSTERILE SMALL FRAGMENT LCP SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|194.84||||194.84|175.35|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|194.84||||194.84|131.16|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|194.84||||194.84|151.39|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|194.84||||194.84|112.61|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|194.84||||194.84|58.46|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|194.84||||194.84|112.61|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|194.84||||194.84|131.16|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|194.84||||194.84|131.16|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|194.84||||194.84|151.39|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|194.84||||194.84|112.61|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|194.84||||194.84|165.61|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|194.84||||194.84|175.35|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|194.84||||194.84|151.39|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.84||||194.84|151.39|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|194.84||||194.84|112.61|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.84||||194.84|136.38|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|194.84||||194.84|131.16|175.35|58.46
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA [141500]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.84||||194.84|||
10023|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L6 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|194.84||||194.84|131.16|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|194.84||||194.84|175.35|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|194.84||||194.84|112.61|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|194.84||||194.84|131.16|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|194.84||||194.84|151.39|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|194.84||||194.84|151.39|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|194.84||||194.84|151.39|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|194.84||||194.84|131.16|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|194.84||||194.84|112.61|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|194.84||||194.84|58.46|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|194.84||||194.84|131.16|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|194.84||||194.84|175.35|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|194.84||||194.84|165.61|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|194.84||||194.84|112.61|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.84||||194.84|136.38|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.84||||194.84|151.39|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|194.84||||194.84|112.61|175.35|58.46
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA [141500]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|194.84||||194.84|||
10024|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L8 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|194.84||||194.84|175.35|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|194.84||||194.84|151.39|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|194.84||||194.84|131.16|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|194.84||||194.84|151.39|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|194.84||||194.84|131.16|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|<Self-pay>|<Self-pay>|194.84||||194.84|58.46|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|194.84||||194.84|112.61|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|194.84||||194.84|112.61|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|194.84||||194.84|131.16|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|194.84||||194.84|112.61|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|194.84||||194.84|151.39|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|194.84||||194.84|165.61|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|194.84||||194.84|175.35|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|194.84||||194.84|151.39|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|194.84||||194.84|112.61|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|194.84||||194.84|136.38|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|194.84||||194.84|131.16|175.35|58.46
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|GEHA [1415]|GEHA [141500]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|194.84||||194.84|||
10025|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L20 MM OD2.7 MM ODSEC5 MM CORTEX SELF TAP SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE MODULAR MINI FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|194.84||||194.84|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10026|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L10 MM OD3.5 MM CORTEX SELF TAP SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|158.18||||158.18|122.91|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|AETNA [1015]|AETNA ACO WILCO [101532]|158.18||||158.18|106.49|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|CIGNA [1260]|CIGNA PPO [126025]|158.18||||158.18|91.43|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|<Self-pay>|<Self-pay>|158.18||||158.18|47.45|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|MULTIPLAN [1680]|HMA [168003]|158.18||||158.18|122.91|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|158.18||||158.18|91.43|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|158.18||||158.18|106.49|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|158.18||||158.18|122.91|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|158.18||||158.18|106.49|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|158.18||||158.18|134.46|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|158.18||||158.18|142.37|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|158.18||||158.18|91.43|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|158.18||||158.18|122.91|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|158.18||||158.18|98.07|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|158.18||||158.18|106.49|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|158.18||||158.18|91.43|142.37|47.45
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|CHAMPVA [1240]|CHAMP VA [124000]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|GEHA [1415]|GEHA [141500]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|BCBS [1155]|BCBS KS FEDERAL [115566]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|158.18||||158.18|||
100264|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|DEVICE SUTURE STRATAFIX PDO 2-0 SH SPIRAL L14 CM ABSORBABLE KNOTLESS TISSUE CONTROL 2 ARM DYED|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|158.18||||158.18|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|636.30||||636.30|428.36|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|636.30||||636.30|494.41|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|636.30||||636.30|367.78|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|636.30||||636.30|572.67|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|636.30||||636.30|540.86|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|636.30||||636.30|367.78|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|636.30||||636.30|428.36|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS [1155]|BCBS KS FEDERAL [115566]|636.30||||636.30|572.67|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA [1015]|AETNA ACO WILCO [101532]|636.30||||636.30|428.36|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CIGNA [1260]|CIGNA PPO [126025]|636.30||||636.30|367.78|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|<Self-pay>|<Self-pay>|636.30||||636.30|190.89|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|636.30||||636.30|494.41|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|636.30||||636.30|428.36|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|636.30||||636.30|445.41|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|636.30||||636.30|494.41|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MULTIPLAN [1680]|HMA [168003]|636.30||||636.30|494.41|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|636.30||||636.30|367.78|572.67|190.89
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|GEHA [1415]|GEHA [141500]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|636.30||||636.30|||
100267|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT ACETABULAR ENDO II -3 MM TAPER HIP|CHAMPVA [1240]|CHAMP VA [124000]|636.30||||636.30|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|992.63||||992.63|668.24|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|992.63||||992.63|771.27|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|992.63||||992.63|668.24|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|<Self-pay>|<Self-pay>|992.63||||992.63|297.79|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MULTIPLAN [1680]|HMA [168003]|992.63||||992.63|771.27|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|992.63||||992.63|573.74|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|992.63||||992.63|771.27|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CIGNA [1260]|CIGNA PPO [126025]|992.63||||992.63|573.74|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|992.63||||992.63|668.24|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|992.63||||992.63|893.37|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|992.63||||992.63|843.73|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|992.63||||992.63|893.37|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|992.63||||992.63|573.74|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|992.63||||992.63|573.74|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|992.63||||992.63|771.27|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|992.63||||992.63|694.84|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|992.63||||992.63|668.24|893.37|297.79
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|CHAMPVA [1240]|CHAMP VA [124000]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|GEHA [1415]|GEHA [141500]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|992.63||||992.63|||
100268|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CENTRALIZER STEM 16MM HIP DISTAL PMMA POSITIONER STERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|992.63||||992.63|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10027|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L12 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5914.18||||5914.18|4595.32|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5914.18||||5914.18|3981.42|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CIGNA [1260]|CIGNA PPO [126025]|5914.18||||5914.18|3418.39|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|5914.18||||5914.18|3981.42|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|<Self-pay>|<Self-pay>|5914.18||||5914.18|1774.26|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|5914.18||||5914.18|3418.39|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MULTIPLAN [1680]|HMA [168003]|5914.18||||5914.18|4595.32|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5914.18||||5914.18|2720.52|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|5914.18||||5914.18|2720.52|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|5914.18||||5914.18|4595.32|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|GEHA [1415]|GEHA [141500]|5914.18||||5914.18|2720.52|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|5914.18||||5914.18|3981.42|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5914.18||||5914.18|2720.52|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5914.18||||5914.18|4595.32|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5914.18||||5914.18|3418.39|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5914.18||||5914.18|3981.42|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5914.18||||5914.18|4139.92|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|5914.18||||5914.18|5322.76|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS [1155]|BCBS KS FEDERAL [115566]|5914.18||||5914.18|5322.76|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|5914.18||||5914.18|5027.05|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5914.18||||5914.18|3418.39|5322.76|1774.26
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5914.18||||5914.18|||
100272|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SPHERE GLENOID THK2 MM CONCENTRIC OD32 MM SHOULDER|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5914.18||||5914.18|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|755.61||||755.61|508.67|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|755.61||||755.61|587.11|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|755.61||||755.61|436.74|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BCBS KS FEDERAL [115566]|755.61||||755.61|680.05|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|755.61||||755.61|680.05|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|755.61||||755.61|436.74|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|755.61||||755.61|508.67|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|755.61||||755.61|642.27|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CIGNA [1260]|CIGNA PPO [126025]|755.61||||755.61|436.74|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA [1015]|AETNA ACO WILCO [101532]|755.61||||755.61|508.67|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|<Self-pay>|<Self-pay>|755.61||||755.61|226.69|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|755.61||||755.61|587.11|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|755.61||||755.61|528.92|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|755.61||||755.61|508.67|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|755.61||||755.61|587.11|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MULTIPLAN [1680]|HMA [168003]|755.61||||755.61|587.11|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|755.61||||755.61|436.74|680.05|226.69
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|GEHA [1415]|GEHA [141500]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|755.61||||755.61|||
100273|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW PERIPHERAL 4.5X20MM|CHAMPVA [1240]|CHAMP VA [124000]|755.61||||755.61|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5914.18||||5914.18|4595.32|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5914.18||||5914.18|3981.42|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CIGNA [1260]|CIGNA PPO [126025]|5914.18||||5914.18|3418.39|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|5914.18||||5914.18|3981.42|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|<Self-pay>|<Self-pay>|5914.18||||5914.18|1774.26|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5914.18||||5914.18|2720.52|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|5914.18||||5914.18|2720.52|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|HMA [168003]|5914.18||||5914.18|4595.32|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|5914.18||||5914.18|3418.39|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|5914.18||||5914.18|3981.42|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|5914.18||||5914.18|4595.32|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|GEHA [1415]|GEHA [141500]|5914.18||||5914.18|2720.52|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BCBS KS FEDERAL [115566]|5914.18||||5914.18|5322.76|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|5914.18||||5914.18|5027.05|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|5914.18||||5914.18|5322.76|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5914.18||||5914.18|2720.52|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5914.18||||5914.18|4595.32|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5914.18||||5914.18|3418.39|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5914.18||||5914.18|3418.39|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5914.18||||5914.18|4139.92|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5914.18||||5914.18|3981.42|5322.76|1774.26
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5914.18||||5914.18|||
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]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|5914.18||||5914.18|||
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]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5914.18||||5914.18|||
100274|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|CUP HUMERAL THK4 MM OD32 MM SHOULDER|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|5914.18||||5914.18|||
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]|4827.90||||4827.90|3250.14|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4827.90||||4827.90|3751.28|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4827.90||||4827.90|4345.11|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4827.90||||4827.90|4103.72|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4827.90||||4827.90|2790.53|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4827.90||||4827.90|2790.53|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4827.90||||4827.90|3250.14|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS [1155]|BCBS KS FEDERAL [115566]|4827.90||||4827.90|4345.11|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA [1015]|AETNA ACO WILCO [101532]|4827.90||||4827.90|3250.14|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CIGNA [1260]|CIGNA PPO [126025]|4827.90||||4827.90|2790.53|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4827.90||||4827.90|3751.28|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4827.90||||4827.90|3250.14|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4827.90||||4827.90|3379.53|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4827.90||||4827.90|3751.28|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|MULTIPLAN [1680]|HMA [168003]|4827.90||||4827.90|3751.28|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4827.90||||4827.90|2790.53|4345.11|1448.37
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|<Self-pay>|<Self-pay>|4827.90||||4827.90|1448.37|4345.11|1448.37
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]|4827.90||||4827.90|||
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]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4827.90||||4827.90|||
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]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4827.90||||4827.90|||
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]|4827.90||||4827.90|||
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]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|GEHA [1415]|GEHA [141500]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4827.90||||4827.90|||
100275|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|INSERT HUMERAL X3 STANDARD H4 MM OD32 MM SHOULDER|CHAMPVA [1240]|CHAMP VA [124000]|4827.90||||4827.90|||
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|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
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>|125.80||||125.80|37.74|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
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|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
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|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
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|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
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|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
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|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
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 NNJ PRIME HMO [102003]|125.80||||125.80|||
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 [141500]|125.80||||125.80|||
10028|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L14 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
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]|125.80||||125.80|||
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]|125.80||||125.80|||
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|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
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|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
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]|125.80||||125.80|||
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|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
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]|125.80||||125.80|||
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]|125.80||||125.80|||
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|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10029|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L16 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10030|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L18 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6896.27||||6896.27|4642.57|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6896.27||||6896.27|4827.39|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6896.27||||6896.27|3986.05|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6896.27||||6896.27|5358.4|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6896.27||||6896.27|3172.29|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|6896.27||||6896.27|6206.65|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|6896.27||||6896.27|5861.83|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|BCBS [1155]|BCBS KS FEDERAL [115566]|6896.27||||6896.27|6206.65|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6896.27||||6896.27|3986.05|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|6896.27||||6896.27|4642.57|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6896.27||||6896.27|3172.29|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|6896.27||||6896.27|3986.05|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|<Self-pay>|<Self-pay>|6896.27||||6896.27|2068.88|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|AETNA [1015]|AETNA ACO WILCO [101532]|6896.27||||6896.27|4642.57|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|CIGNA [1260]|CIGNA PPO [126025]|6896.27||||6896.27|3986.05|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|GEHA [1415]|GEHA [141500]|6896.27||||6896.27|3172.29|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|6896.27||||6896.27|3172.29|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|6896.27||||6896.27|5358.4|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6896.27||||6896.27|4642.57|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6896.27||||6896.27|5358.4|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|MULTIPLAN [1680]|HMA [168003]|6896.27||||6896.27|5358.4|6206.65|2068.88
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6896.27||||6896.27|||
100304|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL ACCOLADE C 127 D 6 49 MM OFFSET L158 MM HIP CEMENT|CHAMPVA [1240]|CHAMP VA [124000]|6896.27||||6896.27|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10031|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L22 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10032|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L24 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10033|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L26 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10034|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10035|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L30 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10036|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L32 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4.40||||4.40|3.42|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4.40||||4.40|2.96|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4.40||||4.40|3.42|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|4.40||||4.40|1.32|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|4.40||||4.40|1.32|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|4.40||||4.40|1.32|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|<Self-pay>|<Self-pay>|4.40||||4.40|1.32|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|4.40||||4.40|2.96|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4.40||||4.40|2.54|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4.40||||4.40|2.96|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4.40||||4.40|2.54|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4.40||||4.40|3.74|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4.40||||4.40|3.74|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4.40||||4.40|3.74|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4.40||||4.40|3.74|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4.40||||4.40|3.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4.40||||4.40|3.96|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4.40||||4.40|3.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|GEHA [1415]|GEHA [141500]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4.40||||4.40|3.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MULTIPLAN [1680]|HMA [168003]|4.40||||4.40|3.42|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4.40||||4.40|3.42|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4.40||||4.40|3.42|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4.40||||4.40|2.96|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4.40||||4.40|2.54|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4.40||||4.40|2.54|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4.40||||4.40|2.73|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4.40||||4.40|2.73|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4.40||||4.40|2.73|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4.40||||4.40|2.73|113.22|1.32
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|1.32
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4.40||||4.40|||
10037|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FINASTERIDE 5 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4.40||||4.40|||
10037|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L34 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10038|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L36 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10039|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L38 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
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]|125.80||||125.80|84.69|113.22|37.74
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 COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
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|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
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]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
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|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
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]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
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|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
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>|125.80||||125.80|37.74|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
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 PPO [126025]|125.80||||125.80|72.71|113.22|37.74
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|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
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|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
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|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
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|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
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]|125.80||||125.80|||
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|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
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]|125.80||||125.80|||
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|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
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|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
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]|125.80||||125.80|||
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]|125.80||||125.80|||
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]|125.80||||125.80|||
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|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
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 MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
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]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
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 [141500]|125.80||||125.80|||
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|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
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]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
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|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
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 NNJ PRIME HMO [102003]|125.80||||125.80|||
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|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|10.32||||10.32|6.95|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|10.32||||10.32|8.02|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|10.32||||10.32|6.95|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|10.32||||10.32|5.96|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|10.32||||10.32|5.96|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|10.32||||10.32|6.95|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|<Self-pay>|<Self-pay>|10.32||||10.32|3.1|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|10.32||||10.32|5.96|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|10.32||||10.32|8.77|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|10.32||||10.32|9.29|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|10.32||||10.32|8.02|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|10.32||||10.32|8.02|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10.32||||10.32|8.02|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|10.32||||10.32|6.95|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|10.32||||10.32|5.96|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10.32||||10.32|6.4|113.22|3.1
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|3.1
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|10.32||||10.32|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|10.32||||10.32|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|GEHA [1415]|GEHA [141500]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|10.32||||10.32|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10.32||||10.32|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|10.32||||10.32|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|10.32||||10.32|||
10041|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLECAINIDE 100 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|10.32||||10.32|||
10041|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L45 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1757.50||||1757.50|1089.65|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1757.50||||1757.50|1015.84|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1757.50||||1757.50|1183.15|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1757.50||||1757.50|1365.58|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|1757.50||||1757.50|1365.58|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1757.50||||1757.50|1493.88|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1757.50||||1757.50|1581.75|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1757.50||||1757.50|1183.15|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1757.50||||1757.50|1015.84|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1757.50||||1757.50|1015.84|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|1757.50||||1757.50|1183.15|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|1757.50||||1757.50|527.25|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PPO [126025]|1757.50||||1757.50|1015.84|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1757.50||||1757.50|1365.58|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1757.50||||1757.50|1183.15|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1757.50||||1757.50|1365.58|1581.75|527.25
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS FEDERAL [115566]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1757.50||||1757.50|||
100417|ERX|0250 - PHARMACY-GENERAL|SILDENAFIL (PULMONARY HYPERTENSION) 10 MG/12.5 ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|1757.50||||1757.50|||
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|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
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|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
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|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
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>|125.80||||125.80|37.74|113.22|37.74
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|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
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|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
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 PPO [126025]|125.80||||125.80|72.71|113.22|37.74
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]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
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]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
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|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
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 COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
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]|125.80||||125.80|84.69|113.22|37.74
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|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
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 NNJ PRIME HMO [102003]|125.80||||125.80|||
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|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
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]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
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 [141500]|125.80||||125.80|||
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
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]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
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 MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
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|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
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]|125.80||||125.80|||
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|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
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]|125.80||||125.80|||
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]|125.80||||125.80|||
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|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
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|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
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|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
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]|125.80||||125.80|||
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]|125.80||||125.80|||
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|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10043|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM FULL THREAD L55 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|15.58||||15.58|12.11|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|15.58||||15.58|9.01|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|15.58||||15.58|10.49|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|15.58||||15.58|9.01|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|15.58||||15.58|9.01|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|15.58||||15.58|10.49|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|<Self-pay>|<Self-pay>|15.58||||15.58|4.67|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|15.58||||15.58|13.24|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|15.58||||15.58|10.49|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|15.58||||15.58|14.02|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MULTIPLAN [1680]|HMA [168003]|15.58||||15.58|12.11|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|15.58||||15.58|12.11|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|15.58||||15.58|12.11|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|15.58||||15.58|10.49|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|15.58||||15.58|9.01|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|15.58||||15.58|9.66|113.22|4.67
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|4.67
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|15.58||||15.58|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|15.58||||15.58|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|GEHA [1415]|GEHA [141500]|15.58||||15.58|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|15.58||||15.58|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|15.58||||15.58|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|15.58||||15.58|||
10044|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE SMALL HEXAGONAL NONSTERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10044|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUCONAZOLE 100 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|15.58||||15.58|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|502.68||||502.68|338.4|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|502.68||||502.68|311.66|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|502.68||||502.68|290.55|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|502.68||||502.68|283.01|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|502.68||||502.68|452.41|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|BCBS [1155]|BCBS KS FEDERAL [115566]|502.68||||502.68|452.41|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|502.68||||502.68|290.55|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|502.68||||502.68|427.28|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|502.68||||502.68|338.4|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|502.68||||502.68|283.01|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|502.68||||502.68|390.58|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|502.68||||502.68|290.55|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|<Self-pay>|<Self-pay>|502.68||||502.68|150.81|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|AETNA [1015]|AETNA ACO WILCO [101532]|502.68||||502.68|338.4|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|GEHA [1415]|GEHA [141500]|502.68||||502.68|283.01|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|CIGNA [1260]|CIGNA PPO [126025]|502.68||||502.68|290.55|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|502.68||||502.68|283.01|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|502.68||||502.68|390.58|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|502.68||||502.68|338.4|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|502.68||||502.68|390.58|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|MULTIPLAN [1680]|HMA [168003]|502.68||||502.68|390.58|452.41|150.81
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|502.68||||502.68|||
100447|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CATHETER BALLOON DILATATION ARMADA L135 CM L60 MM ODSEC4 MM OTW LOW PROFILE TIP ACCEPTS .035 IN GUIDEWIRE PTA|CHAMPVA [1240]|CHAMP VA [124000]|502.68||||502.68|||
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|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
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|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
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]|126.94||||126.94|85.46|114.25|38.08
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|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
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]|126.94||||126.94|85.46|114.25|38.08
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>|126.94||||126.94|38.08|114.25|38.08
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|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
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 PPO [126025]|126.94||||126.94|73.37|114.25|38.08
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|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
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|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
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]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
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]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
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|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
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|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
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|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
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 COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
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]|126.94||||126.94|85.46|114.25|38.08
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 NNJ PRIME HMO [102003]|126.94||||126.94|||
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|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
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|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
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]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
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 [141500]|126.94||||126.94|||
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 MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
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]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
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 MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
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|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
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]|126.94||||126.94|||
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]|126.94||||126.94|||
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]|126.94||||126.94|||
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|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
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|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
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|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
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|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
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]|126.94||||126.94|||
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]|126.94||||126.94|||
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|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 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]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 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]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10046|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L16 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 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]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 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]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10047|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L18 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10048|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L20 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|148.00||||148.00|115|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|148.00||||148.00|5.17|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|148.00||||148.00|5.17|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|148.00||||148.00|5.17|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|148.00||||148.00|99.63|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|148.00||||148.00|115|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA PPO [126025]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA PPO [126025]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA PPO [126025]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|148.00||||148.00|44.4|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|148.00||||148.00|44.4|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|148.00||||148.00|44.4|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|148.00||||148.00|44.4|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|148.00||||148.00|99.63|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|148.00||||148.00|85.54|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|148.00||||148.00|5.17|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|148.00||||148.00|5.17|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|148.00||||148.00|5.17|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|148.00||||148.00|99.63|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|148.00||||148.00|85.54|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|148.00||||148.00|5.17|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS FEDERAL [115566]|148.00||||148.00|5.34|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|148.00||||148.00|5.07|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|148.00||||148.00|5.07|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|148.00||||148.00|5.07|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|148.00||||148.00|5.07|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS FEDERAL [115566]|148.00||||148.00|5.34|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS FEDERAL [115566]|148.00||||148.00|5.34|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS FEDERAL [115566]|148.00||||148.00|5.34|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|148.00||||148.00|133.2|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|148.00||||148.00|133.2|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|148.00||||148.00|133.2|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 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]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 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]|126.94||||126.94|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|148.00||||148.00|133.2|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA PPO [126025]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|148.00||||148.00|115|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|148.00||||148.00|115|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|148.00||||148.00|5.17|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|148.00||||148.00|115|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|148.00||||148.00|99.63|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|148.00||||148.00|85.54|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|148.00||||148.00|85.54|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|148.00||||148.00|5.27|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148.00||||148.00|103.6|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148.00||||148.00|103.6|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148.00||||148.00|103.6|133.2|5.07
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|148.00||||148.00|103.6|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|133.2|5.07
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|148.00||||148.00|||
10049|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 200 MG/100 ML IN SOD. CHLORIDE (ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|148.00||||148.00|||
10049|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L22 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|280.00||||280.00|196|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|280.00||||280.00|196|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|280.00||||280.00|10.54|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|280.00||||280.00|10.54|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|280.00||||280.00|10.54|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|280.00||||280.00|188.5|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|280.00||||280.00|217.56|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|280.00||||280.00|217.56|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|280.00||||280.00|217.56|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|280.00||||280.00|217.56|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|280.00||||280.00|252|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|280.00||||280.00|252|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|280.00||||280.00|252|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS FEDERAL [115566]|280.00||||280.00|10.68|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|280.00||||280.00|10.15|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|280.00||||280.00|10.15|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS FEDERAL [115566]|280.00||||280.00|10.68|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|280.00||||280.00|10.54|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|280.00||||280.00|10.54|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|280.00||||280.00|10.54|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|280.00||||280.00|161.84|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|280.00||||280.00|10.34|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|280.00||||280.00|10.34|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|280.00||||280.00|10.34|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|280.00||||280.00|161.84|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|280.00||||280.00|10.15|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS [1155]|BCBS KS FEDERAL [115566]|280.00||||280.00|10.68|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA [1015]|AETNA ACO WILCO [101532]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|280.00||||280.00|84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|280.00||||280.00|84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|<Self-pay>|<Self-pay>|280.00||||280.00|84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MULTIPLAN [1680]|HMA [168003]|280.00||||280.00|217.56|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA PPO [126025]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA PPO [126025]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CIGNA [1260]|CIGNA PPO [126025]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|280.00||||280.00|217.56|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|280.00||||280.00|161.84|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|280.00||||280.00|217.56|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|280.00||||280.00|217.56|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|280.00||||280.00|217.56|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|280.00||||280.00|188.5|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 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]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 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]|126.94||||126.94|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|GEHA [1415]|GEHA [141500]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|280.00||||280.00|188.5|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|280.00||||280.00|10.34|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|280.00||||280.00|10.34|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|280.00||||280.00|10.34|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|280.00||||280.00|217.56|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|280.00||||280.00|196|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|280.00||||280.00|217.56|252|10.15
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|280.00||||280.00|217.56|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|252|10.15
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|280.00||||280.00|||
10050|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L24 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|280.00||||280.00|||
10050|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|FLUCONAZOLE 400 MG/200 ML IN SOD. CHLORIDE(ISO) INTRAVENOUS PIGGYBACK|CHAMPVA [1240]|CHAMP VA [124000]|280.00||||280.00|||
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|CHAMPVA [1240]|CHAMP VA [124000]|5409.00||||5409.00|1191.09|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|5409.00||||5409.00|4202.79|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|5409.00||||5409.00|1224|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|5409.00||||5409.00|3212.95|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|5409.00||||5409.00|3244|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|CIGNA [1260]|CIGNA PPO [126025]|5409.00||||5409.00|3126.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|GEHA [1415]|GEHA [141500]|5409.00||||5409.00|3244|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|<Self-pay>|<Self-pay>|5409.00||||5409.00|1622.7|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|AETNA [1015]|AETNA ACO WILCO [101532]|5409.00||||5409.00|3212.95|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|5409.00||||5409.00|3126.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|5409.00||||5409.00|1224|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|5409.00||||5409.00|3244|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|5409.00||||5409.00|3126.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|5409.00||||5409.00|3212.95|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|5409.00||||5409.00|4202.79|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|5409.00||||5409.00|1248|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|5409.00||||5409.00|1497.2|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|BCBS [1155]|BCBS KS FEDERAL [115566]|5409.00||||5409.00|1576|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|5409.00||||5409.00|4868.1|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|MULTIPLAN [1680]|HMA [168003]|5409.00||||5409.00|4202.79|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|5409.00||||5409.00|3244|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|5409.00||||5409.00|4202.79|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|5409.00||||5409.00|3212.95|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|5409.00||||5409.00|3126.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|5409.00||||5409.00|1215.4|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|5409.00||||5409.00|1248|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|5409.00||||5409.00|3786.3|4868.1|1191.09
100509|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|ONABOTULINUMTOXINA 200 UNIT SOLUTION FOR INJECTION|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|5409.00||||5409.00|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 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]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 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]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10051|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L26 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 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]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 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]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10052|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L56 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|8458.80||||8458.80|5694.46|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|8458.80||||8458.80|5921.16|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|8458.80||||8458.80|4889.19|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|8458.80||||8458.80|6572.49|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|8458.80||||8458.80|3891.05|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|8458.80||||8458.80|7189.98|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|8458.80||||8458.80|7612.92|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|8458.80||||8458.80|4889.19|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|8458.80||||8458.80|7612.92|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|8458.80||||8458.80|5694.46|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|8458.80||||8458.80|3891.05|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|8458.80||||8458.80|4889.19|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|<Self-pay>|<Self-pay>|8458.80||||8458.80|2537.64|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|8458.80||||8458.80|5694.46|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|CIGNA [1260]|CIGNA PPO [126025]|8458.80||||8458.80|4889.19|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|GEHA [1415]|GEHA [141500]|8458.80||||8458.80|3891.05|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|8458.80||||8458.80|3891.05|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|8458.80||||8458.80|6572.49|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|8458.80||||8458.80|5694.46|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|8458.80||||8458.80|6572.49|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|MULTIPLAN [1680]|HMA [168003]|8458.80||||8458.80|6572.49|7612.92|2537.64
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|8458.80||||8458.80|||
100524|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|STEM FEMORAL TAPERLOC PPS TITANIUM 133 D STANDARD OFFSET TAPER L140 MM OD10 MM HIP PRESS FIT REDUCE DISTAL STERILE|CHAMPVA [1240]|CHAMP VA [124000]|8458.80||||8458.80|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|10537.88||||10537.88|8187.94|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|10537.88||||10537.88|7094.1|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|10537.88||||10537.88|8187.94|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|10537.88||||10537.88|4847.43|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|GEHA [1415]|GEHA [141500]|10537.88||||10537.88|4847.43|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|CIGNA [1260]|CIGNA PPO [126025]|10537.88||||10537.88|6090.9|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|AETNA [1015]|AETNA ACO WILCO [101532]|10537.88||||10537.88|7094.1|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|<Self-pay>|<Self-pay>|10537.88||||10537.88|3161.36|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|10537.88||||10537.88|6090.9|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|10537.88||||10537.88|4847.43|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|10537.88||||10537.88|7094.1|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|10537.88||||10537.88|6090.9|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|MULTIPLAN [1680]|HMA [168003]|10537.88||||10537.88|8187.94|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|BCBS [1155]|BCBS KS FEDERAL [115566]|10537.88||||10537.88|9484.1|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|10537.88||||10537.88|8957.2|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|10537.88||||10537.88|9484.1|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|10537.88||||10537.88|4847.43|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|10537.88||||10537.88|8187.94|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|10537.88||||10537.88|6090.9|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|10537.88||||10537.88|7376.52|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|10537.88||||10537.88|7094.1|9484.1|3161.36
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|CHAMPVA [1240]|CHAMP VA [124000]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|10537.88||||10537.88|||
100527|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM 1 CHAMBER IS-1 CONNECTOR|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|10537.88||||10537.88|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 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]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 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]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10053|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L58 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|MULTIPLAN [1680]|HMA [168003]|22182.18||||22182.18|17235.55|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|22182.18||||22182.18|17235.55|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|22182.18||||22182.18|14933.04|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|22182.18||||22182.18|17235.55|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|22182.18||||22182.18|10203.8|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|22182.18||||22182.18|14933.04|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|CIGNA [1260]|CIGNA PPO [126025]|22182.18||||22182.18|12821.3|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|<Self-pay>|<Self-pay>|22182.18||||22182.18|6654.65|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|22182.18||||22182.18|12821.3|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|22182.18||||22182.18|10203.8|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|22182.18||||22182.18|14933.04|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|22182.18||||22182.18|12821.3|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|GEHA [1415]|GEHA [141500]|22182.18||||22182.18|10203.8|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|22182.18||||22182.18|18854.85|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|22182.18||||22182.18|19963.96|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|22182.18||||22182.18|19963.96|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22182.18||||22182.18|10203.8|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|22182.18||||22182.18|12821.3|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22182.18||||22182.18|17235.55|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22182.18||||22182.18|15527.53|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|22182.18||||22182.18|14933.04|19963.96|6654.65
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22182.18||||22182.18|||
100531|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE LEFT TOTAL STABILIZE STERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|22182.18||||22182.18|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|6.04||||6.04|3.74|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|6.04||||6.04|3.49|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|6.04||||6.04|4.07|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|6.04||||6.04|4.69|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|6.04||||6.04|5.44|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|6.04||||6.04|5.13|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|6.04||||6.04|4.07|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|6.04||||6.04|3.49|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|6.04||||6.04|3.49|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MULTIPLAN [1680]|HMA [168003]|6.04||||6.04|4.69|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA [1015]|AETNA ACO WILCO [101532]|6.04||||6.04|4.07|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|<Self-pay>|<Self-pay>|6.04||||6.04|1.81|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CIGNA [1260]|CIGNA PPO [126025]|6.04||||6.04|3.49|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|6.04||||6.04|4.69|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|6.04||||6.04|4.07|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|1.81
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|6.04||||6.04|4.69|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|1.81
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|6.04||||6.04|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|6.04||||6.04|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|6.04||||6.04|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|BCBS [1155]|BCBS KS FEDERAL [115566]|6.04||||6.04|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|GEHA [1415]|GEHA [141500]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|6.04||||6.04|||
10054|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUDROCORTISONE 0.1 MG TABLET|CHAMPVA [1240]|CHAMP VA [124000]|6.04||||6.04|||
10054|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L60 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 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]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 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]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10055|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L62 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 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]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 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]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10056|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L64 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 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]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 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]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10057|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L66 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 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]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 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]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10058|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 3.5 MM L68 MM OD4.5 MM ODSEC8 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|13115.59||||13115.59|10190.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|13115.59||||13115.59|8829.42|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|13115.59||||13115.59|10190.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|13115.59||||13115.59|6033.17|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|GEHA [1415]|GEHA [141500]|13115.59||||13115.59|6033.17|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|AETNA [1015]|AETNA ACO WILCO [101532]|13115.59||||13115.59|8829.42|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|<Self-pay>|<Self-pay>|13115.59||||13115.59|3934.68|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|13115.59||||13115.59|7580.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|13115.59||||13115.59|6033.17|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|CIGNA [1260]|CIGNA PPO [126025]|13115.59||||13115.59|7580.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|13115.59||||13115.59|8829.42|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|13115.59||||13115.59|7580.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|MULTIPLAN [1680]|HMA [168003]|13115.59||||13115.59|10190.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|13115.59||||13115.59|13115.59|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|BCBS [1155]|BCBS KS FEDERAL [115566]|13115.59||||13115.59|13115.59|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|13115.59||||13115.59|11804.03|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|13115.59||||13115.59|6033.17|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|13115.59||||13115.59|10190.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|13115.59||||13115.59|7580.81|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|13115.59||||13115.59|9180.91|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|13115.59||||13115.59|8829.42|13115.59|3934.68
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|CHAMPVA [1240]|CHAMP VA [124000]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|13115.59||||13115.59|||
100588|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|GRAFT ZENITH SPIRALZ ILIAC LEG|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|13115.59||||13115.59|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|126.94||||126.94|85.46|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|126.94||||126.94|88.86|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|126.94||||126.94|73.37|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|126.94||||126.94|114.25|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|126.94||||126.94|114.25|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|126.94||||126.94|73.37|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|126.94||||126.94|85.46|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|126.94||||126.94|107.9|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|126.94||||126.94|98.63|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|126.94||||126.94|73.37|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|<Self-pay>|<Self-pay>|126.94||||126.94|38.08|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|126.94||||126.94|85.46|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|126.94||||126.94|73.37|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|126.94||||126.94|98.63|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|126.94||||126.94|85.46|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|126.94||||126.94|98.63|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|126.94||||126.94|98.63|114.25|38.08
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|GEHA [1415]|GEHA [141500]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|126.94||||126.94|||
10059|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL L70 MM OD4.5 MM CORTEX SELF TAP LARGE HEXAGONAL SOCKET NONSTERILE LARGE FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|126.94||||126.94|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|12298.20||||12298.20|9555.71|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12298.20||||12298.20|8279.15|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|12298.20||||12298.20|9555.71|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|12298.20||||12298.20|5657.17|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA PPO [126025]|12298.20||||12298.20|7108.36|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA ACO WILCO [101532]|12298.20||||12298.20|8279.15|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|12298.20||||12298.20|3689.46|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|12298.20||||12298.20|7108.36|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12298.20||||12298.20|5657.17|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA [141500]|12298.20||||12298.20|5657.17|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|12298.20||||12298.20|8279.15|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12298.20||||12298.20|7108.36|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|HMA [168003]|12298.20||||12298.20|9555.71|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|12298.20||||12298.20|10453.47|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS FEDERAL [115566]|12298.20||||12298.20|11068.38|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|12298.20||||12298.20|11068.38|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12298.20||||12298.20|5657.17|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12298.20||||12298.20|9555.71|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12298.20||||12298.20|7108.36|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12298.20||||12298.20|8608.74|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12298.20||||12298.20|8279.15|11068.38|3689.46
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12298.20||||12298.20|||
100623|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 1 SMALL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|12298.20||||12298.20|8279.15|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|12298.20||||12298.20|8608.74|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|12298.20||||12298.20|7108.36|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|12298.20||||12298.20|9555.71|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|12298.20||||12298.20|5657.17|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|12298.20||||12298.20|11068.38|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS FEDERAL [115566]|12298.20||||12298.20|11068.38|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|12298.20||||12298.20|10453.47|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|12298.20||||12298.20|7108.36|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|12298.20||||12298.20|8279.15|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|12298.20||||12298.20|5657.17|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|12298.20||||12298.20|7108.36|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|<Self-pay>|<Self-pay>|12298.20||||12298.20|3689.46|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|AETNA [1015]|AETNA ACO WILCO [101532]|12298.20||||12298.20|8279.15|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|CIGNA [1260]|CIGNA PPO [126025]|12298.20||||12298.20|7108.36|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|GEHA [1415]|GEHA [141500]|12298.20||||12298.20|5657.17|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|12298.20||||12298.20|5657.17|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|12298.20||||12298.20|9555.71|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|12298.20||||12298.20|8279.15|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|12298.20||||12298.20|9555.71|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|MULTIPLAN [1680]|HMA [168003]|12298.20||||12298.20|9555.71|11068.38|3689.46
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|12298.20||||12298.20|||
100624|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|BASEPLATE TIBIAL 2 SMALL KNEE MODULAR ROTATE HINGE|CHAMPVA [1240]|CHAMP VA [124000]|12298.20||||12298.20|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10063|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM FULL THREAD L18 MM W2.5 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP SMALL HEXAGONAL LOW PROFILE NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|125.80||||125.80|97.74|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|125.80||||125.80|84.69|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|125.80||||125.80|97.74|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|125.80||||125.80|97.74|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|125.80||||125.80|84.69|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|125.80||||125.80|72.71|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|125.80||||125.80|72.71|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|125.80||||125.80|97.74|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|125.80||||125.80|84.69|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|125.80||||125.80|37.74|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|125.80||||125.80|72.71|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|125.80||||125.80|106.93|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|125.80||||125.80|113.22|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|125.80||||125.80|72.71|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|125.80||||125.80|113.22|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|125.80||||125.80|88.06|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|125.80||||125.80|84.69|113.22|37.74
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|125.80||||125.80|||
10067|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE TITANIUM 2.5 MM FULL THREAD L28 MM OD3.5 MM ODSEC6 MM CORTEX SELF TAP LOW PROFILE HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|125.80||||125.80|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|757.20||||757.20|588.34|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|757.20||||757.20|437.66|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|757.20||||757.20|588.34|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|757.20||||757.20|509.75|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|757.20||||757.20|588.34|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|757.20||||757.20|437.66|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|757.20||||757.20|437.66|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|757.20||||757.20|509.75|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|MULTIPLAN [1680]|HMA [168003]|757.20||||757.20|588.34|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|757.20||||757.20|509.75|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|757.20||||757.20|643.62|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|757.20||||757.20|509.75|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|757.20||||757.20|681.48|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|757.20||||757.20|437.66|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|<Self-pay>|<Self-pay>|757.20||||757.20|227.16|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|757.20||||757.20|530.04|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|BCBS [1155]|BCBS KS FEDERAL [115566]|757.20||||757.20|681.48|681.48|227.16
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|GEHA [1415]|GEHA [141500]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|757.20||||757.20|||
100673|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L12 MM OD1.5 MM SELF TAP LOCK VARIABLE ANGLE STARDRIVE NONSTERILE PURPLE HAND PLATE SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|757.20||||757.20|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|267.25||||267.25|179.91|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|267.25||||267.25|187.07|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|BCBS [1155]|BCBS KS FEDERAL [115566]|267.25||||267.25|240.52|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|267.25||||267.25|154.47|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|267.25||||267.25|227.16|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|267.25||||267.25|179.91|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|267.25||||267.25|154.47|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|267.25||||267.25|154.47|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|<Self-pay>|<Self-pay>|267.25||||267.25|80.18|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|CIGNA [1260]|CIGNA PPO [126025]|267.25||||267.25|154.47|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|267.25||||267.25|207.65|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|267.25||||267.25|240.52|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|267.25||||267.25|207.65|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|267.25||||267.25|179.91|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|AETNA [1015]|AETNA ACO WILCO [101532]|267.25||||267.25|179.91|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|MULTIPLAN [1680]|HMA [168003]|267.25||||267.25|207.65|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|267.25||||267.25|207.65|240.52|80.18
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|CHAMPVA [1240]|CHAMP VA [124000]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|GEHA [1415]|GEHA [141500]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|267.25||||267.25|||
100676|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL T4 L11 MM OD1.5 MM CORTEX SELF TAP SELF RETAIN STARDRIVE NONSTERILE MODULAR MINI FRAGMENT SYSTEM|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|267.25||||267.25|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1242.82||||1242.82|718.35|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AETNA [1015]|AETNA ACO WILCO [101532]|1242.82||||1242.82|836.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1242.82||||1242.82|1056.4|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1242.82||||1242.82|1118.54|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1242.82||||1242.82|836.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|<Self-pay>|<Self-pay>|1242.82||||1242.82|372.85|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1242.82||||1242.82|965.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1242.82||||1242.82|718.35|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1242.82||||1242.82|718.35|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1242.82||||1242.82|836.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1242.82||||1242.82|869.97|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS [1155]|BCBS KS FEDERAL [115566]|1242.82||||1242.82|1118.54|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|CIGNA [1260]|CIGNA PPO [126025]|1242.82||||1242.82|718.35|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1242.82||||1242.82|965.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MULTIPLAN [1680]|HMA [168003]|1242.82||||1242.82|965.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1242.82||||1242.82|836.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1242.82||||1242.82|965.67|1118.54|372.85
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|GEHA [1415]|GEHA [141500]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|CHAMPVA [1240]|CHAMP VA [124000]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1242.82||||1242.82|||
100684|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE ASNIS III STAINLESS STEEL PARTIAL THREAD REVERSE CUT FLUTE L85 MM L40 MM OD6.5 MM CANNULATED SELF TAP SELF DRILL LOW PROFILE HEAD NONSTERILE ACCEPTS 3.2 MM GUIDEWIRE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1242.82||||1242.82|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10069|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 10 MG CAPSULE|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|1.44||||1.44|0.97|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|<Self-pay>|<Self-pay>|1.44||||1.44|0.43|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|1.44||||1.44|1.12|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|1.44||||1.44|0.83|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|1.44||||1.44|0.89|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|1.44||||1.44|0.83|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|1.44||||1.44|1.22|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|1.44||||1.44|1.12|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MULTIPLAN [1680]|HMA [168003]|1.44||||1.44|1.12|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|1.44||||1.44|0.83|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|1.44||||1.44|1.3|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|1.44||||1.44|0.97|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|1.44||||1.44|1.12|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|1.44||||1.44|0.97|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA [1015]|AETNA ACO WILCO [101532]|1.44||||1.44|0.97|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CIGNA [1260]|CIGNA PPO [126025]|1.44||||1.44|0.83|1.3|0.43
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|CHAMPVA [1240]|CHAMP VA [124000]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|GEHA [1415]|GEHA [141500]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|BCBS [1155]|BCBS KS FEDERAL [115566]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|1.44||||1.44|||
10070|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLUOXETINE 20 MG CAPSULE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|1.44||||1.44|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4980.36||||4980.36|3352.78|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4980.36||||4980.36|2878.65|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4980.36||||4980.36|3352.78|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4980.36||||4980.36|4482.32|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4980.36||||4980.36|3486.25|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4980.36||||4980.36|2878.65|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4980.36||||4980.36|3869.74|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4980.36||||4980.36|3869.74|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4980.36||||4980.36|3352.78|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4980.36||||4980.36|4233.31|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4980.36||||4980.36|3869.74|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|AETNA [1015]|AETNA ACO WILCO [101532]|4980.36||||4980.36|3352.78|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|MULTIPLAN [1680]|HMA [168003]|4980.36||||4980.36|3869.74|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|<Self-pay>|<Self-pay>|4980.36||||4980.36|1494.11|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|CIGNA [1260]|CIGNA PPO [126025]|4980.36||||4980.36|2878.65|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4980.36||||4980.36|2878.65|4482.32|1494.11
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|BCBS [1155]|BCBS KS FEDERAL [115566]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|GEHA [1415]|GEHA [141500]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|CHAMPVA [1240]|CHAMP VA [124000]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4980.36||||4980.36|||
100709|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COIL EMBOLIZATION PENUMBRA COIL 400 RUBY STANDARD L10 CM OD.02 IN ODSEC4 MM PERIPHERAL COMPLEX LARGE VOLUME FULLY DETACHABLE RESHEATHABLE FRAME|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4980.36||||4980.36|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|2067.98||||2067.98|1861.18|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|2067.98||||2067.98|1606.82|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|2067.98||||2067.98|1282.14|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|2067.98||||2067.98|1757.78|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|2067.98||||2067.98|1392.16|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|2067.98||||2067.98|1195.29|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|2067.98||||2067.98|1392.16|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|2067.98||||2067.98|1606.82|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|CIGNA [1260]|CIGNA PPO [126025]|2067.98||||2067.98|1195.29|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|2067.98||||2067.98|1606.82|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AETNA [1015]|AETNA ACO WILCO [101532]|2067.98||||2067.98|1392.16|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|<Self-pay>|<Self-pay>|2067.98||||2067.98|620.4|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|2067.98||||2067.98|1195.29|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|MULTIPLAN [1680]|HMA [168003]|2067.98||||2067.98|1606.82|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|2067.98||||2067.98|1195.29|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|2067.98||||2067.98|1392.16|1861.18|620.4
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS [1155]|BCBS KS FEDERAL [115566]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|CHAMPVA [1240]|CHAMP VA [124000]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|GEHA [1415]|GEHA [141500]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|2067.98||||2067.98|||
100739|SUP|0272 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-STERI|CUTTER ARTHROSCOPIC FLIPCUTTER II OD9.5 MM ACL PCL DRILL PIN FEMORAL SOCKET HOUSING RETROGRADE STERILE LATEX FREE DISPOSABLE BLUE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|2067.98||||2067.98|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|4296.57||||4296.57|2552.16|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|4296.57||||4296.57|287.76|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|4296.57||||4296.57|3866.91|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|MULTIPLAN [1680]|HMA [168003]|4296.57||||4296.57|3338.43|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|4296.57||||4296.57|3338.43|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|4296.57||||4296.57|2483.42|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|4296.57||||4296.57|2552.16|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|4296.57||||4296.57|3338.43|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|4296.57||||4296.57|2483.42|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS [1155]|BCBS KS FEDERAL [115566]|4296.57||||4296.57|302.91|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|4296.57||||4296.57|2552.16|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|4296.57||||4296.57|2483.42|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|CIGNA [1260]|CIGNA PPO [126025]|4296.57||||4296.57|2483.42|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|4296.57||||4296.57|3007.6|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|<Self-pay>|<Self-pay>|4296.57||||4296.57|1288.97|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|AETNA [1015]|AETNA ACO WILCO [101532]|4296.57||||4296.57|2552.16|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|4296.57||||4296.57|3338.43|3866.91|287.76
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|GEHA [1415]|GEHA [141500]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|CHAMPVA [1240]|CHAMP VA [124000]|4296.57||||4296.57|||
100740|ERX|0636 - PHARMACY-EXTENSION OF 025X-DRUGS REQUIRING|IBUTILIDE FUMARATE 0.1 MG/ML INTRAVENOUS SOLUTION|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|4296.57||||4296.57|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|MULTIPLAN [1680]|HMA [168003]|14112.84||||14112.84|10965.68|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|14112.84||||14112.84|10965.68|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|14112.84||||14112.84|10965.68|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|CIGNA [1260]|CIGNA PPO [126025]|14112.84||||14112.84|8157.22|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|GEHA [1415]|GEHA [141500]|14112.84||||14112.84|6491.91|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|14112.84||||14112.84|6491.91|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|AETNA [1015]|AETNA ACO WILCO [101532]|14112.84||||14112.84|9500.76|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|<Self-pay>|<Self-pay>|14112.84||||14112.84|4233.85|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|14112.84||||14112.84|8157.22|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|14112.84||||14112.84|6491.91|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|14112.84||||14112.84|8157.22|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|14112.84||||14112.84|6491.91|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|BCBS [1155]|BCBS KS FEDERAL [115566]|14112.84||||14112.84|12701.56|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|14112.84||||14112.84|12701.56|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|14112.84||||14112.84|9500.76|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|14112.84||||14112.84|11995.91|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|14112.84||||14112.84|8157.22|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|14112.84||||14112.84|9878.99|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|14112.84||||14112.84|9500.76|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|14112.84||||14112.84|10965.68|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|14112.84||||14112.84|9500.76|12701.56|4233.85
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|CHAMPVA [1240]|CHAMP VA [124000]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|14112.84||||14112.84|||
100741|SUP|0275 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-PACEM|SYSTEM CARDIAC ASSURITY MRI THK6 MM W50 MM X H47 MM 10.4 CC 20 GM PACEMAKER LEAD 2 CHAMBER IS-1 CONNECTOR|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|14112.84||||14112.84|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22182.18||||22182.18|17235.55|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|22182.18||||22182.18|12821.3|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|22182.18||||22182.18|19963.96|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|22182.18||||22182.18|14933.04|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|22182.18||||22182.18|12821.3|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|22182.18||||22182.18|12821.3|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|22182.18||||22182.18|10203.8|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|<Self-pay>|<Self-pay>|22182.18||||22182.18|6654.65|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|CIGNA [1260]|CIGNA PPO [126025]|22182.18||||22182.18|12821.3|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|22182.18||||22182.18|17235.55|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|22182.18||||22182.18|10203.8|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|22182.18||||22182.18|14933.04|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|MULTIPLAN [1680]|HMA [168003]|22182.18||||22182.18|17235.55|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|22182.18||||22182.18|19963.96|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22182.18||||22182.18|10203.8|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|22182.18||||22182.18|17235.55|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|GEHA [1415]|GEHA [141500]|22182.18||||22182.18|10203.8|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|22182.18||||22182.18|18854.85|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|22182.18||||22182.18|14933.04|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|22182.18||||22182.18|14933.04|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22182.18||||22182.18|15527.53|19963.96|6654.65
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22182.18||||22182.18|||
100778|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 3 KNEE RIGHT TOTAL STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|22182.18||||22182.18|17235.55|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|22182.18||||22182.18|10203.8|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA [1015]|AETNA ACO WILCO [101532]|22182.18||||22182.18|14933.04|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|CIGNA [1260]|CIGNA PPO [126025]|22182.18||||22182.18|12821.3|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|MULTIPLAN [1680]|HMA [168003]|22182.18||||22182.18|17235.55|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|22182.18||||22182.18|12821.3|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|22182.18||||22182.18|14933.04|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|22182.18||||22182.18|17235.55|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|GEHA [1415]|GEHA [141500]|22182.18||||22182.18|10203.8|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|<Self-pay>|<Self-pay>|22182.18||||22182.18|6654.65|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|22182.18||||22182.18|10203.8|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BCBS KS FEDERAL [115566]|22182.18||||22182.18|19963.96|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|22182.18||||22182.18|10203.8|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|22182.18||||22182.18|19963.96|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|22182.18||||22182.18|17235.55|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|22182.18||||22182.18|14933.04|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|22182.18||||22182.18|14933.04|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|22182.18||||22182.18|12821.3|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|22182.18||||22182.18|18854.85|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|22182.18||||22182.18|12821.3|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|22182.18||||22182.18|15527.53|19963.96|6654.65
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|CHAMPVA [1240]|CHAMP VA [124000]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|22182.18||||22182.18|||
100780|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|COMPONENT FEMORAL TRIATHLON COCR 5 KNEE RIGHT TOTAL STABILIZE STERILE|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|22182.18||||22182.18|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|288.00||||288.00|166.46|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|288.00||||288.00|193.88|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|288.00||||288.00|244.8|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|MULTIPLAN [1680]|HMA [168003]|288.00||||288.00|223.78|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|288.00||||288.00|223.78|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|288.00||||288.00|166.46|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|<Self-pay>|<Self-pay>|288.00||||288.00|86.4|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|288.00||||288.00|259.2|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|288.00||||288.00|166.46|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|CIGNA [1260]|CIGNA PPO [126025]|288.00||||288.00|166.46|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|288.00||||288.00|193.88|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|288.00||||288.00|193.88|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|288.00||||288.00|223.78|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|288.00||||288.00|178.56|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|288.00||||288.00|223.78|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|AETNA [1015]|AETNA ACO WILCO [101532]|288.00||||288.00|193.88|259.2|86.4
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|VA CCN OPTUM [3920]|VA CCN OPTUM [392000]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|PEAK PACE SOLUTIONS MANAGED MEDICARE [2960]|PEAK PACE SOLUTIONS MANAGED MEDICARE [296000]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|MANAGED MEDICARE [1600]|MANAGED MEDICARE OTHER [160000]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|HUMANA MEDICARE REPLACEMENT [1525]|HUMANA MEDICARE ADVANTAGE/PPO/GOLD [152503]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|BCBS [1155]|BCBS KS FEDERAL [115566]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|GEHA [1415]|GEHA [141500]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|EARLY DETECTION WORKS [2950]|EARLY DETECTION WORKS [295000]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|UMR - ARDENT EMPLOYEE [2036]|UMR - ARDENT EMPLOYEE [203601]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|CHAMPVA [1240]|CHAMP VA [124000]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|KANSAS MEDICAID [3670]|MEDIKAN KANSAS MEDICAID [367001]|288.00||||288.00|||
10080|ERX|0637 - PHARMACY-EXTENSION OF 025X-SELF-ADMINISTRAB|FLURBIPROFEN 0.03 % EYE DROPS|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|288.00||||288.00|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA [1015]|AETNA ACO WILCO [101532]|127.39||||127.39|85.76|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|<Self-pay>|<Self-pay>|127.39||||127.39|38.22|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HEALTHPARTNERS [1500]|HEALTHPARTNERS [150000]|127.39||||127.39|73.63|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|1199 SEIU BENEFIT FUND [3505]|1199 SEIU BENEFIT FUND [350500]|127.39||||127.39|85.76|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CIGNA [1260]|CIGNA PPO [126025]|127.39||||127.39|73.63|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN POSTAL WORKERS UNION [1070]|AMERICAN POSTAL WORKERS [107000]|127.39||||127.39|73.63|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MULTIPLAN [1680]|HMA [168003]|127.39||||127.39|98.98|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PROVIDR'S CARE NETWORK [2955]|PROVIDR'S CARE NETWORK [295500]|127.39||||127.39|114.65|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|FIRST HEALTH [1375]|FIRST HEALTH NETWORK [137501]|127.39||||127.39|98.98|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|COVENTRY HEALTHCARE [1320]|COVENTRY [132001]|127.39||||127.39|85.76|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|ADMINISTRATIVE CONCEPTS [1005]|ADMINISTRATIVE CONCEPTS [100502]|127.39||||127.39|98.98|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS FEDERAL [115566]|127.39||||127.39|114.65|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|NATIONAL ASSOCIATION OF LETTER CARRIERS [1695]|NALC [169500]|127.39||||127.39|73.63|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS [1155]|BCBS KS BLUE CHOICE [115540]|127.39||||127.39|108.28|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|MERITAIN AETNA [3685]|MERITAIN AETNA ARDENT EMPLOYEE [368502]|127.39||||127.39|85.76|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|HUMANA COMMERCIAL [2140]|HUMANA COMMERCIAL [214001]|127.39||||127.39|89.17|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AMERICAN HEALTHCARE [1055]|AMERICAN HEALTHCARE [105500]|127.39||||127.39|98.98|114.65|38.22
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|CHAMPVA [1240]|CHAMP VA [124000]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|GEHA [1415]|GEHA [141500]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UHC MEDICAID REPLACEMENT [3755]|UHC MEDICAID COMMUNITY PLAN [375501]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UMR [2035]|UNITED MEDICAL RESOURCES [203503]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICARE REPLACEMENT [1020]|AETNA NNJ PRIME HMO [102003]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|AETNA MEDICAID REPLACEMENT [3510]|AETNA BETTER HEALTH [351001]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|PEAK PACE SOLUTIONS [3715]|PEAK PACE SOLUTIONS [371500]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE [2060]|UHC MEDICA CHOICE [206030]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|SUNFLOWER STATE HLTH PLAN [3745]|SUNFLOWER STATE HLTH PLAN [374500]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|UNITED HEALTHCARE MEDICARE REPLACEMENT [2065]|UHC MEDICARE ADVANTAGE [206511]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|BCBS MEDICARE REPLACEMENT [1160]|BLUE CROSS MEDICARE ADVANTAGE OOS [116005]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BONE STAINLESS STEEL 2.5 MM PARTIAL THREAD L16 MM L6 MM OD3.5 MM ODSEC6 MM SHAFT SPHERICAL HEAD SMALL HEXAGONAL SOCKET NONSTERILE SMALL FRAGMENT SET|KANSAS HEALTH ADVANTAGE [2965]|KANSAS HEALTH ADVANTAGE MEDICARE [296500]|127.39||||127.39|||
10081|SUP|0278 - MEDICAL/SURGICAL SUPPLIES AND DEVICES-OTHER|SCREW BO